Relationships between menopausal and mood symptoms and EEG sleep measures in a multi-ethnic sample of middle-aged women: the SWAN sleep study.

PubMed

Kravitz, Howard M; Avery, Elizabeth; Sowers, Maryfran; Bromberger, Joyce T; Owens, Jane F; Matthews, Karen A; Hall, Martica; Zheng, Huiyong; Gold, Ellen B; Buysse, Daniel J

2011-09-01

Examine associations of vasomotor and mood symptoms with visually scored and computer-generated measures of EEG sleep. Cross-sectional analysis. Community-based in-home polysomnography (PSG). 343 African American, Caucasian, and Chinese women; ages 48-58 years; pre-, peri- or post-menopausal; participating in the Study of Women's Health Across the Nation Sleep Study (SWAN Sleep Study). None. Measures included PSG-assessed sleep duration, continuity, and architecture, delta sleep ratio (DSR) computed from automated counts of delta wave activity, daily diary-assessed vasomotor symptoms (VMS), questionnaires to collect mood (depression, anxiety) symptoms, medication, and lifestyle information, and menopausal status using bleeding criteria. Sleep outcomes were modeled using linear regression. Nocturnal VMS were associated with longer sleep time. Higher anxiety symptom scores were associated with longer sleep latency and lower sleep efficiency, but only in women reporting nocturnal VMS. Contrary to expectations, VMS and mood symptoms were unrelated to either DSR or REM latency. Vasomotor symptoms moderated associations of anxiety with EEG sleep measures of sleep latency and sleep efficiency and was associated with longer sleep duration in this multi-ethnic sample of midlife women.

Prevalence of menopausal symptoms in Asian midlife women: a systematic review.

PubMed

Islam, M Rakibul; Gartoulla, P; Bell, R J; Fradkin, P; Davis, S R

2015-04-01

To systematically review published articles for the prevalence of menopausal symptoms in Asian women. A comprehensive and systematic literature search was performed using MEDLINE, EMBASE, PsycINFO, CINAHL, SCOPUS and Google scholar in June 2013 to retrieve all English-language studies that included information on the prevalence of menopausal symptoms in women living in Asian countries. Risk of bias of included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies. Twenty-three independent studies met our inclusion criteria. Physical symptoms were the most prevalent symptoms compared to psychological, vasomotor and sexual symptoms. There was a wide variation in the prevalence of all symptoms across the menopausal stages due to the differences in modes of recruitment, study design, sampling procedures, the time frame over which symptoms were assessed and use of different diagnostic or screening tools. A high level of bias was observed for both external and internal validity for most studies. Although there is a wide variation in the reported prevalence of menopausal symptoms, physical symptoms predominate, followed by psychological symptoms, vasomotor symptoms and sexual symptoms. Further studies of representative samples are necessary to understand whether the variations in prevalence reporting are a function of methodological issues or due to ethnic, cultural or other socioeconomic differences.

Mothers' exercise during pregnancy programs vasomotor function in adult offspring

USDA-ARS?s Scientific Manuscript database

Background: The intrauterine environment is influenced by maternal behavior and known to influence lifelong atherosclerotic disease susceptibility in offspring. The purpose of this investigation was to test the hypothesis that maternal exercise during pregnancy increases endothelial function in offs...

Effects of low-dose paroxetine 7.5 mg on weight and sexual function during treatment of vasomotor symptoms associated with menopause

PubMed Central

Portman, David J.; Kaunitz, Andrew M.; Kazempour, Kazem; Mekonnen, Hana; Bhaskar, Sailaja; Lippman, Joel

2014-01-01

Abstract Objective Two phase 3, randomized, placebo-controlled trials demonstrated that low-dose paroxetine 7.5 mg reduced the frequency and severity of vasomotor symptoms (VMS) associated with menopause and had a favorable tolerability profile. The impact of paroxetine 7.5 mg on body weight and sexual function was evaluated in a pooled analysis. Methods Postmenopausal women aged 40 years or older who had moderate to severe VMS were randomly assigned to receive paroxetine 7.5 mg or placebo once daily for 12 or 24 weeks. Assessments included changes in body mass index (BMI) and weight, Arizona Sexual Experiences Scale score, Hot Flash–Related Daily Interference Scale sexuality subscore, and adverse events related to weight or sexual dysfunction. Results Pooled efficacy and safety populations comprised 1,174 and 1,175 participants, respectively. Baseline values were similar for median weight (∼75 kg), median BMI (∼28 kg/m2), and the proportion of women with sexual dysfunction (∼58%). No clinically meaningful or statistically significant changes from baseline in weight or sexual function assessments occurred in the paroxetine 7.5 mg group. Small but statistically significant increases in weight and BMI were observed in the placebo group only on week 4. No significant difference between treatment groups was observed in the proportion of participants who had 7% or higher gain in body weight on week 4, 12, or 24. Rates of adverse events suggestive of sexual dysfunction were low and similar in both treatment groups. Conclusions Paroxetine 7.5 mg does not cause weight gain or negative changes in libido when used to treat menopause-associated VMS in postmenopausal women. PMID:24552977

Adding Agnus Castus and Magnolia to Soy Isoflavones Relieves Sleep Disturbances Besides Postmenopausal Vasomotor Symptoms-Long Term Safety and Effectiveness

PubMed Central

De Franciscis, Pasquale; Grauso, Flavio; Luisi, Anna; Schettino, Maria Teresa; Torella, Marco; Colacurci, Nicola

2017-01-01

The effectiveness for vasomotor symptoms and sleep disorders plus the long-term safety of a nutraceutical combination of agnus-castus and magnolia extracts combined with soy isoflavones (SI) and lactobacilli were assessed in postmenopausal women. A controlled study was carried out in menopausal women comparing this nutraceutical combination (ESP group) with a formulation containing isoflavones alone (C group) at the dosage recommended. The Kuppermann index, The Pittsburgh Sleep Quality Index (PSQI), and Short Form 36 (SF-36) were determined at baseline, three, six and 12 months. Endometrial thickness, mammary density and liver function were evaluated at baseline and after 12 months. One hundred and eighty women were enrolled in the study (100 in the ESP group and 80 in the C group). At the end of the treatment, mammary density, endometrial thickness, and hepatic function did not show substantial differences between groups. The Kuppermann index and particularly the tendency for hot flashes progressively and significantly decreased in frequency and severity during ESP versus C treatment. At the same time, a significant increase in sleep quality and psychophysical wellness parameters was observed in the ESP versus C groups. No adverse events were observed. Agnus-castus and magnolia, combined with SI + lactobacilli, can effectively and safely be used in symptomatic postmenopausal women, mainly when quality of sleep is the most disturbing complaint. The endometrium, mammary glands and liver function were unaffected after 12 months of treatment. PMID:28208808

Adding Agnus Castus and Magnolia to Soy Isoflavones Relieves Sleep Disturbances Besides Postmenopausal Vasomotor Symptoms-Long Term Safety and Effectiveness.

PubMed

De Franciscis, Pasquale; Grauso, Flavio; Luisi, Anna; Schettino, Maria Teresa; Torella, Marco; Colacurci, Nicola

2017-02-13

The effectiveness for vasomotor symptoms and sleep disorders plus the long-term safety of a nutraceutical combination of agnus-castus and magnolia extracts combined with soy isoflavones (SI) and lactobacilli were assessed in postmenopausal women. A controlled study was carried out in menopausal women comparing this nutraceutical combination (ESP group) with a formulation containing isoflavones alone (C group) at the dosage recommended. The Kuppermann index, The Pittsburgh Sleep Quality Index (PSQI), and Short Form 36 (SF-36) were determined at baseline, three, six and 12 months. Endometrial thickness, mammary density and liver function were evaluated at baseline and after 12 months. One hundred and eighty women were enrolled in the study (100 in the ESP group and 80 in the C group). At the end of the treatment, mammary density, endometrial thickness, and hepatic function did not show substantial differences between groups. The Kuppermann index and particularly the tendency for hot flashes progressively and significantly decreased in frequency and severity during ESP versus C treatment. At the same time, a significant increase in sleep quality and psychophysical wellness parameters was observed in the ESP versus C groups. No adverse events were observed. Agnus-castus and magnolia, combined with SI + lactobacilli, can effectively and safely be used in symptomatic postmenopausal women, mainly when quality of sleep is the most disturbing complaint. The endometrium, mammary glands and liver function were unaffected after 12 months of treatment.

Sudomotor, skin vasomotor, and cardiovascular reflexes in 3 clinical forms of Lewy body disease.

PubMed

Akaogi, Y; Asahina, M; Yamanaka, Y; Koyama, Y; Hattori, T

2009-07-07

To elucidate the differences among dementia with Lewy bodies (DLB), Parkinson disease with dementia (PDD), and Parkinson disease without dementia (PD), with respect to the involvement of the autonomic nervous system, we clinically investigated the cutaneous and cardiovascular autonomic functions in patients with Lewy body disease. We studied 36 patients with Lewy body disorders, including 12 patients with DLB (age, 75.4 +/- 5.9 years), 12 patients with PDD (71.0 +/- 6.8 years), and 12 patients with PD (70.9 +/- 4.2 years), and 12 healthy control subjects (69.9 +/- 5.3 years). Sympathetic sweat response (SSwR) and skin vasomotor reflex (SkVR) on the palm were recorded to estimate the cutaneous sympathetic function, and the head-up tilt test was performed and coefficient of variation of R-R intervals (CV(R-R)) was studied to estimate the cardiovascular function. The patients with DLB, patients with PDD, and patients with PD showed severely reduced SSwR amplitudes, significantly lower than that in the controls. The mean SkVR amplitudes in the patients with DLB and patients with PDD were significantly lower than that in the controls, but not in the patients with PD. The mean decreases in the systolic blood pressure during the head-up tilt test in the patients with DLB and patients with PDD were less than that in the controls. The mean CV(R-R) value was significantly lower in the patients with DLB. Sudomotor function on the palm may be severely affected in Lewy body disorders, while skin vasomotor function and the cardiovascular system may be more severely affected in dementia with Lewy bodies and Parkinson disease with dementia than in Parkinson disease.

Hypercalcemia: an unusual etiology of a common menopausal symptom.

PubMed

Roark, Abrea; Wilson, Brian P; Eyster, Kathleen M; Timmerman, Gary L; Allard, Brandon L; Hansen, Keith A

2011-06-01

To describe atypical vasomotor symptoms that were secondary to primary hyperparathyroidism. Case report. University medical center. A 57-year-old, postmenopausal woman with recalcitrant hot flushes. Parathyroid adenomectomy. Vasomotor symptom relief. Postoperative relief of atypical vasomotor symptoms. A patient 17 years postmenopause presented with atypical vasomotor symptoms that did not respond to hormone therapy and proved to be due to hypercalcemia secondary to primary hyperparathyroidism. An atypical manifestation of a common condition or an uncharacteristic therapeutic response should alert health care providers to the possibility of a different diagnosis. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Benefits of Synchrotron Microangiography for Dynamic Studies of Smooth Muscle and Endothelial Roles in the Pathophysiology of Vascular Disease

NASA Astrophysics Data System (ADS)

Pearson, James T.; Schwenke, Daryl O.; Jenkins, Mathew J.; Edgley, Amanda J.; Sonobe, Takashi; Ishibashi-Ueda, Hatsue; Umetani, Keiji; Eppel, Gabriela A.; Evans, Roger G.; Okura, Yasuhiko; Shirai, Mikiyasu

2010-07-01

Changes in endothelial and smooth muscle function compromise organ perfusion in the chronic disease states of diabetes, atherosclerosis and hypertension. Moreover, vascular dysfunction increases the likelihood of lethal acute events such as myocardial infarction and stroke, which are now leading causes of adult mortality. Many circulating and local tissue factors in these disease states contribute to impaired vasomotor regulation of the arterial vessels, leading to spasm, chronic constriction and eventually vessel remodelling. X-ray contrast absorption imaging allows assessment of vessel lumen diameter and the factors contributing to steady-state vessel calibre, however, conventional clinical devices (>200 μm resolution) are not adequate to detect microvessels or accurately assess function in real time. Using synchrotron imaging we are now able to detect small vessel calibres (˜30 μm) and quantify regional differences in calibre even under conditions of high heart rate (>500 bpm). Herein we describe recent experiments that were conducted at the Japanese Synchrotron, SPring-8 using anaesthetised Sprague-Dawley rats and C57Bl/6 mice and a synchrotron radiation contrast angiography (single narrow energy bandwidth) approach based on selective arterial injection of iodine contrast agents. Application of this approach to imaging of the heart and other vasculatures are described. Our studies show that within-animal comparisons of 3-4 branching orders of arterial vessels are possible using small bolus contrast injections and appropriate contrast washout times (15-30 min) in many organ systems. Determination of relative calibre changes before and after any treatment allows us to evaluate the contributions of different endogenous factors and ligand-receptor pathways in the maintenance of vasomotor tone. Finally, we will present our findings relating to novel therapies to prevent endothelial dysfunction in heart failure.

Benefits of Synchrotron Microangiography for Dynamic Studies of Smooth Muscle and Endothelial Roles in the Pathophysiology of Vascular Disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pearson, James T.; Department of Physiology, Monash University, 3800 Clayton; Schwenke, Daryl O.

2010-07-23

Changes in endothelial and smooth muscle function compromise organ perfusion in the chronic disease states of diabetes, atherosclerosis and hypertension. Moreover, vascular dysfunction increases the likelihood of lethal acute events such as myocardial infarction and stroke, which are now leading causes of adult mortality. Many circulating and local tissue factors in these disease states contribute to impaired vasomotor regulation of the arterial vessels, leading to spasm, chronic constriction and eventually vessel remodelling. X-ray contrast absorption imaging allows assessment of vessel lumen diameter and the factors contributing to steady-state vessel calibre, however, conventional clinical devices (>200 {mu}m resolution) are not adequatemore » to detect microvessels or accurately assess function in real time. Using synchrotron imaging we are now able to detect small vessel calibres ({approx}30 {mu}m) and quantify regional differences in calibre even under conditions of high heart rate (>500 bpm). Herein we describe recent experiments that were conducted at the Japanese Synchrotron, SPring-8 using anaesthetised Sprague-Dawley rats and C57Bl/6 mice and a synchrotron radiation contrast angiography (single narrow energy bandwidth) approach based on selective arterial injection of iodine contrast agents. Application of this approach to imaging of the heart and other vasculatures are described. Our studies show that within-animal comparisons of 3-4 branching orders of arterial vessels are possible using small bolus contrast injections and appropriate contrast washout times (15-30 min) in many organ systems. Determination of relative calibre changes before and after any treatment allows us to evaluate the contributions of different endogenous factors and ligand-receptor pathways in the maintenance of vasomotor tone. Finally, we will present our findings relating to novel therapies to prevent endothelial dysfunction in heart failure.« less

Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.

PubMed

Reed, Susan D; Guthrie, Katherine A; Newton, Katherine M; Anderson, Garnet L; Booth-LaForce, Cathryn; Caan, Bette; Carpenter, Janet S; Cohen, Lee S; Dunn, Andrea L; Ensrud, Kristine E; Freeman, Ellen W; Hunt, Julie R; Joffe, Hadine; Larson, Joseph C; Learman, Lee A; Rothenberg, Robin; Seguin, Rebecca A; Sherman, Karen J; Sternfeld, Barbara S; LaCroix, Andrea Z

2014-03-01

The purpose of this study was to determine the efficacy of 3 nonhormonal therapies for the improvement of menopause-related quality of life in women with vasomotor symptoms. We conducted a 12-week 3 × 2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, 40-62 years old, were assigned randomly to yoga (n = 107), exercise (n = 106), or usual activity (n = 142) and also assigned randomly to a double-blind comparison of omega-3 (n = 177) or placebo (n = 178) capsules. We performed the following interventions: (1) weekly 90-minute yoga classes with daily at-home practice, (2) individualized facility-based aerobic exercise training 3 times/week, and (3) 0.615 g omega-3 supplement, 3 times/day. The outcomes were assessed with the following scores: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (vasomotor symptoms, psychosocial, physical and sexual). Among 355 randomly assigned women who average age was 54.7 years, 338 women (95%) completed 12-week assessments. Mean baseline vasomotor symptoms frequency was 7.6/day, and the mean baseline total MENQOL score was 3.8 (range, 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% confidence interval, -0.6 to 0; P = .02), vasomotor symptom domain (P = .02), and sexuality domain (P = .03) scores. For women who underwent exercise and omega-3 therapy compared with control subjects, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12 weeks (P = .02). All women become menopausal, and many of them seek medical advice on ways to improve quality of life; little evidence-based information exists. We found that, among healthy sedentary menopausal women, yoga appears to improve menopausal quality of life; the clinical significance of our finding is uncertain because of the modest effect. Copyright © 2014 Mosby, Inc. All rights reserved.

An Intervention to Control Vasomotor Symptoms for Advanced PC Patients on Hormone Therapy

DTIC Science & Technology

2014-08-01

Symptoms for Advanced PC Patients on Hormone Therapy PRINCIPAL INVESTIGATOR: Michael A. Diefenbach, Ph.D. CONTRACTING ORGANIZATION...Control Vasomotor Symptoms for Advanced PC Patients on Hormone Therapy 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-11-1-0604 5c...NOTES 14. ABSTRACT Vasomotor Symptom (Hot Flashes) is a common side-effect of hormone therapy for prostate cancer survivors who experience a rising

Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms.

PubMed

Guthrie, Katherine A; LaCroix, Andrea Z; Ensrud, Kristine E; Joffe, Hadine; Newton, Katherine M; Reed, Susan D; Caan, Bette; Carpenter, Janet S; Cohen, Lee S; Freeman, Ellen W; Larson, Joseph C; Manson, JoAnn E; Rexrode, Kathy; Skaar, Todd C; Sternfeld, Barbara; Anderson, Garnet L

2015-08-01

To describe the effects of six interventions for menopausal vasomotor symptoms relative to control in a pooled analysis, facilitating translation of the results for clinicians and symptomatic women. The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network tested these interventions in three randomized clinical trials. An analysis of pooled individual-level data from three randomized clinical trials is presented. Participants were 899 perimenopausal and postmenopausal women with at least 14 bothersome vasomotor symptoms per week. Interventions included 10-20 mg escitalopram per day, nonaerobic yoga, aerobic exercise, 1.8 g per day omega-3 fatty acid supplementation, 0.5 mg low-dose oral 17-beta-estradiol (E2) per day, and 75 mg low-dose venlafaxine XR per day. The main outcome measures were changes from baseline in mean daily vasomotor symptom frequency and bother during 8-12 weeks of treatment. Linear regression models estimated differences in outcomes between each intervention and corresponding control group adjusted for baseline characteristics. Models included trial-specific intercepts, effects of the baseline outcome measure, and time. The 8-week reduction in vasomotor symptom frequency from baseline relative to placebo was similar for escitalopram at -1.4 per day (95% confidence interval [CI] -2.7 to -0.2), low-dose E2 at -2.4 (95% CI -3.4 to -1.3), and venlafaxine at -1.8 (95% CI -2.8 to -0.8); vasomotor symptom bother reduction was minimal and did not vary across these three pharmacologic interventions (mean -0.2 to -0.3 relative to placebo). No effects on vasomotor symptom frequency or bother were seen with aerobic exercise, yoga, or omega-3 supplements. These analyses suggest that escitalopram, low-dose E2, and venlafaxine provide comparable, modest reductions in vasomotor symptom frequency and bother among women with moderate hot flushes. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00894543 (MsFLASH 01), NCT01178892 (MsFLASH 02), and NCT01418209 (MsFLASH 03).

Psychological but not vasomotor symptoms are associated with temperament and character traits.

PubMed

Kokras, N; Papadopoulos, L; Zervas, I M; Spyropoulou, A; Stamatelopoulos, K; Rizos, D; Creatsa, M; Augoulea, A; Papadimitriou, G N; Lambrinoudaki, I

2014-08-01

Recent evidence suggests that climacteric symptoms may be intensified by specific temperament and personality traits in postmenopausal women. In this study we investigate Cloninger's model of personality in relation to menopausal symptoms. One-hundred and seventy peri- and postmenopausal women consecutively recruited from a menopause clinic of an academic hospital completed the Cloninger's Temperament and Character Inventory (TCI-140) which measures four dimensions of temperament: Harm avoidance, Novelty seeking, Reward dependence and Persistence, as well as three dimensions of character: Self-directedness, Cooperativeness, and Self-transcendence. Menopausal somatic, vasomotor and psychological symptoms were also assessed using the Greene Climacteric Scale. In comparison to the norms of the Greek general population, postmenopausal women presented lower scores in Novelty seeking and Reward dependence and higher scores in Persistence, Self-directedness, Cooperativeness and Self-transcendence. Higher harm avoidance (the inclination to avoid potential punishment, be shy and fearful of uncertainty) significantly correlated with anxiety and depressive symptoms while lower Self-directedness (the ability to have the willpower to adapt to or overcome any changes) correlated with depressive symptoms only. By multivariate regression analysis, higher Harm avoidance and lower Self-directedness were independently associated with the presence of depressive symptoms. No significant associations were observed between TCI-140 traits and somatic or vasomotor symptoms. Our findings indicate that most temperament and character traits according to Cloninger's model in peri- and postmenopausal women varied significantly as compared to the general population. Among several traits, high Harm avoidance and low Self-directedness were most strongly associated with psychological climacteric distress but not with somatic and vasomotor symptoms.

Enhanced pain and autonomic responses to ambiguous visual stimuli in chronic Complex Regional Pain Syndrome (CRPS) type I.

PubMed

Cohen, H E; Hall, J; Harris, N; McCabe, C S; Blake, D R; Jänig, W

2012-02-01

Cortical reorganisation of sensory, motor and autonomic systems can lead to dysfunctional central integrative control. This may contribute to signs and symptoms of Complex Regional Pain Syndrome (CRPS), including pain. It has been hypothesised that central neuroplastic changes may cause afferent sensory feedback conflicts and produce pain. We investigated autonomic responses produced by ambiguous visual stimuli (AVS) in CRPS, and their relationship to pain. Thirty CRPS patients with upper limb involvement and 30 age and sex matched healthy controls had sympathetic autonomic function assessed using laser Doppler flowmetry of the finger pulp at baseline and while viewing a control figure or AVS. Compared to controls, there were diminished vasoconstrictor responses and a significant difference in the ratio of response between affected and unaffected limbs (symmetry ratio) to a deep breath and viewing AVS. While viewing visual stimuli, 33.5% of patients had asymmetric vasomotor responses and all healthy controls had a homologous symmetric pattern of response. Nineteen (61%) CRPS patients had enhanced pain within seconds of viewing the AVS. All the asymmetric vasomotor responses were in this group, and were not predictable from baseline autonomic function. Ten patients had accompanying dystonic reactions in their affected limb: 50% were in the asymmetric sub-group. In conclusion, there is a group of CRPS patients that demonstrate abnormal pain networks interacting with central somatomotor and autonomic integrational pathways. © 2011 European Federation of International Association for the Study of Pain Chapters.

Understanding women's experience of memory over the menopausal transition: subjective and objective memory in pre-, peri-, and postmenopausal women.

PubMed

Unkenstein, Anne E; Bryant, Christina A; Judd, Fiona K; Ong, Ben; Kinsella, Glynda J

2016-12-01

Many women complain of forgetfulness during the menopausal transition. This study aimed to examine women's subjective perception of memory and their objective memory performance across the menopausal transition. One hundred thirty women, aged 40 to 60 years were recruited from outpatient Menopause and Gynaecological clinics at the Royal Women's Hospital, Melbourne. Women were divided into menopausal stage groups according to the Stages of Reproductive Aging Workshop criteria based on menstrual patterns. All women completed self-report measures of depressive, anxiety, vasomotor, and sleep symptoms; attitude to menopause; and various aspects of memory, including memory contentment, frequency of forgetting, sense of control over memory, and use of memory strategies. Women also completed a comprehensive neuropsychological evaluation assessing memory and executive function. Comprehensive neuropsychological assessment showed no difference between premenopausal (n = 36), perimenopausal (n = 54), and postmenopausal (n = 40) groups in performance on memory and executive tasks. Perimenopausal women, however, reported significantly more frequent forgetting (η = 0.09, P < 0.01) and less contentment with their memory (η = 0.08, P < 0.01) than pre- and postmenopausal women. Although no impairment was observed in neuropsychological performance, when compared with pre- and postmenopausal women, perimenopausal women were more likely to be dissatisfied with their memory. During the menopausal transition women with a more negative attitude to menopause and more intense depressive, anxiety, vasomotor, and sleep symptoms are more vulnerable to feeling less content with their memory.

Vasomotor symptoms and cardiometabolic risk factors in menopausal women: a MONET Group study.

PubMed

Abdulnour, J; Stacey, D; Dionne, I J; Brochu, M; Doucet, É; Prud'homme, D

2016-08-01

Conflicting results have been reported concerning the prevalence of cardiometabolic risk factors in women experiencing vasomotor symptoms (VMS). To compare cardiometabolic risk factors between women with and without VMS during the menopause transition and to determine the influence of physical activity on the prevalence of VMS. Yearly assessment of women transitioning through menopause included self-reported VMS (hot flushes and night sweats), body composition and fat distribution, fasting glucose, insulin and lipids, and physical activity levels. Eighty-five of the 102 premenopausal women at baseline were included (age: 49.9 ± 2.0 years; body mass index: 23.2 ± 2.2 kg/m(2)). According to linear mixed model analyses, no statistically significant differences were observed for fat mass, lean body mass, body fat distribution indices and cardiometabolic risk factors, when comparing symptomatic vs. asymptomatic women. Neither physical activity levels nor intensity were associated with the prevalence of VMS. Our results suggest that women transitioning through menopause who reported VMS did not show greater deteriorations in body composition, body fat distribution and cardiometabolic risk factors. Furthermore, physical activity levels were not associated with lower prevalence of vasomotor symptoms in the present cohort.

Safety and Efficacy of Black Cohosh and Red Clover for the Management of Vasomotor Symptoms: A Randomized Controlled Trial

PubMed Central

Geller, Stacie E.; Shulman, Lee P.; van Breemen, Richard B.; Banuvar, Suzanne; Zhou, Ying; Epstein, Geena; Hedayat, Samad; Nikolic, Dejan; Krause, Elizabeth C.; Piersen, Colleen E.; Bolton, Judy L.; Pauli, Guido F.; Farnsworth, Norman R.

2009-01-01

Objective The aim of this study was to evaluate the safety and efficacy of black cohosh and red clover compared with placebo for the relief of menopausal vasomotor symptoms. Design This study was a randomized, four-arm, double-blind clinical trial of standardized black cohosh, red clover, placebo and 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (CEE/MPA; n = 89). Primary outcome measures were reduction in vasomotor symptoms (hot flashes and night sweats) by black cohosh and red clover compared with placebo; secondary outcomes included safety evaluation, reduction of somatic symptoms, relief of sexual dysfunction, and overall improvement in quality of life. Results Reductions in number of vasomotor symptoms after 12-month intervention were as follows: black cohosh (34%), red clover (57%), placebo (63%), and CEE/MPA (94%), with only CEE/MPA differing significantly from placebo. Black cohosh and red clover did not significantly reduce the frequency of vasomotor symptoms as compared with placebo. Secondary measures indicated that both botanicals were safe as administered. In general, there were no improvements in other menopausal symptoms. Conclusions Compared with placebo, black cohosh and red clover did not reduce the number of vasomotor symptoms. Safety monitoring indicated that chemically and biologically standardized extracts of black cohosh and red clover were safe during daily administration for 12 months. PMID:19609225

Magnesium and the Athlete.

PubMed

Volpe, Stella Lucia

2015-01-01

Magnesium is the fourth most abundant mineral and the second most abundant intracellular divalent cation in the body. It is a required mineral that is involved in more than 300 metabolic reactions in the body. Magnesium helps maintain normal nerve and muscle function, heart rhythm (cardiac excitability), vasomotor tone, blood pressure, immune system, bone integrity, and blood glucose levels and promotes calcium absorption. Because of magnesium's role in energy production and storage, normal muscle function, and maintenance of blood glucose levels, it has been studied as an ergogenic aid for athletes. This article will cover the general roles of magnesium, magnesium requirements, and assessment of magnesium status as well as the dietary intake of magnesium and its effects on exercise performance. The research articles cited were limited from those published in 2003 through 2014.

Exercise for vasomotor menopausal symptoms.

PubMed

Daley, A; MacArthur, C; Mutrie, N; Stokes-Lampard, H

2007-10-17

Evidence suggests that a high proportion of perimenopausal and early postmenopausal women will experience some menopause symptoms, hot flushes being the most common. The effects caused by falling levels of estrogen may be alleviated by hormone replacement therapy (HRT) but there has been a marked global decline in the prescription and use of HRT due to concerns about the risks and benefits of HRT; consequently many women are now seeking alternatives. As large numbers of women are choosing not to take HRT, it is increasingly important to identify evidence based lifestyle modifications, which can have a positive effect on menopausal symptoms. To examine the effectiveness of any type of exercise intervention in the management of vasomotor menopausal symptoms (hot flushes and night sweats) in perimenopausal and postmenopausal women. Searches of the following electronic bibliographic databases were performed to identify randomised controlled trials: The Cochrane Library (CENTRAL) (Wiley Internet interface) 2006 Issue 2, MEDLINE (Ovid) 1966-May week 4 2006, EMBASE (Ovid) 1980-week 21 2006, PsycINFO (Ovid) 1967-May week 5 2006, Science Citation Index and Social Science Citation Index (Web of Science) 1900-June 2006 and 1956-June 2006 respectively, CINAHL (Ovid) 1982-May week 4 2006, SPORT Discus (ERL WebSPIRS) 1830-2006/04. Randomised controlled trials (RCTs) in which any type of exercise intervention was compared to other treatments or no treatment in the management of menopausal vasomotor symptoms in symptomatic perimenopausal and postmenopausal women. Nineteen reports were deemed potentially eligible, but of these only one met the inclusion criteria and three authors independently extracted data from this trial. Only one very small trial, which compared exercise with HRT, was available for inclusion in this review. Based on within-group analyses the study authors concluded that both interventions were effective in reducing vasomotor symptoms. Between-group trial analyses conducted by reviewers showed that the HRT group experienced significantly fewer hot flushes compared to the exercise group at follow-up. Only one very small trial involving symptomatic women has assessed the effectiveness of exercise in the management of vasomotor menopausal symptoms. Exercise was not as effective as HRT in this trial. We found no evidence from randomised controlled trials on whether exercise is an effective treatment relative to other interventions or no intervention in reducing hot flushes and or night sweats in symptomatic women. No conclusions regarding the effectiveness of exercise as a treatment for vasomotor menopausal symptoms could be made due to a lack of trials.

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders.

PubMed

Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

2016-08-18

Intracoronary acetylcholine provocation testing (ACH-test) is an established method for assessment of epicardial coronary artery spasm in the catheterization laboratory which was introduced more than 30 years ago. Due to the short half-life of acetylcholine it can only be applied directly into the coronary arteries. Several studies have demonstrated the safety and clinical usefulness of this test. However, acetylcholine testing is only rarely applied in the U.S. or Europe. Nevertheless, it has been shown that 62% of Caucasian patients with stable angina and unobstructed coronary arteries on coronary angiography suffer from coronary vasomotor disorders that can be diagnosed with acetylcholine testing. In recent years it has been appreciated that the ACH-test not only assesses the presence of epicardial spasm but that it can also be useful for the detection of coronary microvascular spam. In such cases no epicardial spasm is seen after injection of acetylcholine but ischemic ECG shifts are present together with a reproduction of the patient's symptoms during the test. This article describes the experience with the ACH-test and its implementation in daily clinical routine.

Methods for the design of vasomotor symptom trials: the menopausal strategies: finding lasting answers to symptoms and health network.

PubMed

Newton, Katherine M; Carpenter, Janet S; Guthrie, Katherine A; Anderson, Garnet L; Caan, Bette; Cohen, Lee S; Ensrud, Kristine E; Freeman, Ellen W; Joffe, Hadine; Sternfeld, Barbara; Reed, Susan D; Sherman, Sheryl; Sammel, Mary D; Kroenke, Kurt; Larson, Joseph C; Lacroix, Andrea Z

2014-01-01

This report describes the Menopausal Strategies: Finding Lasting Answers to Symptoms and Health network and methodological issues addressed in designing and implementing vasomotor symptom trials. Established in response to a National Institutes of Health request for applications, the network was charged with conducting rapid throughput randomized trials of novel and understudied available interventions postulated to alleviate vasomotor and other menopausal symptoms. Included are descriptions of and rationale for criteria used for interventions and study selection, common eligibility and exclusion criteria, common primary and secondary outcome measures, consideration of placebo response, establishment of a biorepository, trial duration, screening and recruitment, statistical methods, and quality control. All trial designs are presented, including the following: (1) a randomized, double-blind, placebo-controlled clinical trial designed to evaluate the effectiveness of the selective serotonin reuptake inhibitor escitalopram in reducing vasomotor symptom frequency and severity; (2) a two-by-three factorial design trial to test three different interventions (yoga, exercise, and ω-3 supplementation) for the improvement of vasomotor symptom frequency and bother; and (3) a three-arm comparative efficacy trial of the serotonin-norepinephrine reuptake inhibitor venlafaxine and low-dose oral estradiol versus placebo for reducing vasomotor symptom frequency. The network's structure and governance are also discussed. The methods used in and the lessons learned from the Menopausal Strategies: Finding Lasting Answers to Symptoms and Health trials are shared to encourage and support the conduct of similar trials and to encourage collaborations with other researchers.

Melatonin in perimenopausal and postmenopausal women: associations with mood, sleep, climacteric symptoms, and quality of life.

PubMed

Toffol, Elena; Kalleinen, Nea; Haukka, Jari; Vakkuri, Olli; Partonen, Timo; Polo-Kantola, Päivi

2014-05-01

Melatonin synthesis and secretion are partly modulated by estrogen and progesterone. Changes in melatonin concentrations, possibly related to the menopausal transition, may be associated with climacteric mood, sleep, and vasomotor symptoms. The aims of this study were to compare the serum concentrations of melatonin in perimenopausal and postmenopausal women and to evaluate melatonin's influence on mood, sleep, vasomotor symptoms, and quality of life. We analyzed the data of 17 healthy perimenopausal women (aged 43-51 y) and 18 healthy postmenopausal women (aged 58-71 y) who participated in a prospective study. On study night (9:00 pm-9:00 am), serum melatonin was sampled at 20-minute (9:00 pm-12:00 midnight; 6:00-9:00 am) and 1-hour (12:00 midnight-6:00 am) intervals. Questionnaires were used to assess depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), insomnia and sleepiness (Basic Nordic Sleep Questionnaire [BNSQ]), subjective sleep quality, vasomotor symptoms, and quality of life (EuroQoL). Postmenopausal women had lower nighttime serum melatonin concentrations than perimenopausal women. The duration of melatonin secretion tended to be shorter in postmenopause, whereas melatonin peak time did not differ. Mean melatonin concentrations and exposure levels did not correlate with follicle-stimulating hormone level, estradiol level, body mass index, Beck Depression Inventory score, State-Trait Anxiety Inventory score, BNSQ insomnia score, BNSQ sleepiness score, subjective sleep score, climacteric vasomotor score, or quality of life. In perimenopause, the later is the melatonin peak, the higher is the level of anxiety (P = 0.022), and the longer is the melatonin secretion, the better is the quality of life (P < 0.001). Longitudinal research is needed to better understand the possible contributory role of menopause in lower melatonin levels.

Sustained conduction of vasomotor responses in rat mesenteric arteries in a two-compartment in vitro setup.

PubMed

Palao, Teresa; van Weert, Angela; de Leeuw, Anne; de Vos, Judith; Bakker, Erik N T P; van Bavel, Ed

2018-05-21

Conduction of vasomotor responses may contribute to long-term regulation of resistance artery function and structure. Most previous studies have addressed conduction of vasoactivity only during very brief stimulations. We developed a novel setup that allows the local pharmacological stimulation of arteries in vitro for extended periods of time, and studied the conduction of vasomotor responses in rat mesenteric arteries under those conditions. The new in vitro set up was based on the pressure myograph. The superfusion chamber was divided halfway along the vessel into two compartments, allowing an independent superfusion of the arterial segment in each compartment. Local and remote cumulative concentration-response curves were obtained for a range of vasoactive agents. Additional experiments were performed with the gap junction inhibitor 18β-glycyrrhetinic acid and in absence of the endothelium. Phenylephrine-induced constriction and acetylcholine-induced dilation were conducted over a measured distance up to 2.84 mm, and this conduction was maintained for 5 minutes. Conduction of acetylcholine-induced dilation was inhibited by 18β-glycyrrhetinic acid and conduction of phenylephrine-induced constriction was abolished in absence of the endothelium. Constriction in response to high K + was not conducted. Absence of remote stimulation dampened the local response to phenylephrine. This study demonstrates maintained conduction of vasoactive responses to physiological agonists in rat mesenteric small arteries likely via gap junctions and endothelial cells, providing a possible mechanism for the sustained functional and structural control of arterial networks. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Understanding the physiology of mindfulness: aortic hemodynamics and heart rate variability.

PubMed

May, Ross W; Bamber, Mandy; Seibert, Gregory S; Sanchez-Gonzalez, Marcos A; Leonard, Joseph T; Salsbury, Rebecca A; Fincham, Frank D

2016-01-01

Data were collected to examine autonomic and hemodynamic cardiovascular modulation underlying mindfulness from two independent samples. An initial sample (N = 185) underwent laboratory assessments of central aortic blood pressure and myocardial functioning to investigated the association between mindfulness and cardiac functioning. Controlling for religiosity, mindfulness demonstrated a strong negative relationship with myocardial oxygen consumption and left ventricular work but not heart rate or blood pressure. A second sample (N = 124) underwent a brief (15 min) mindfulness inducing intervention to examine the influence of mindfulness on cardiovascular autonomic modulation via blood pressure variability and heart rate variability. The intervention had a strong positive effect on cardiovascular modulation by decreasing cardiac sympathovagal tone, vasomotor tone, vascular resistance and ventricular workload. This research establishes a link between mindfulness and cardiovascular functioning via correlational and experimental methodologies in samples of mostly female undergraduates. Future directions for research are outlined.

Effects of intermittent theta burst stimulation on cerebral blood flow and cerebral vasomotor reactivity.

PubMed

Pichiorri, Floriana; Vicenzini, Edoardo; Gilio, Francesca; Giacomelli, Elena; Frasca, Vittorio; Cambieri, Chiara; Ceccanti, Marco; Di Piero, Vittorio; Inghilleri, Maurizio

2012-08-01

To determine whether intermittent theta burst stimulation influences cerebral hemodynamics, we investigated changes induced by intermittent theta burst stimulation on the middle cerebral artery cerebral blood flow velocity and vasomotor reactivity to carbon dioxide (CO(2)) in healthy participants. The middle cerebral artery flow velocity and vasomotor reactivity were monitored by continuous transcranial Doppler sonography. Changes in cortical excitability were tested by transcranial magnetic stimulation. In 11 healthy participants, before and immediately after delivering intermittent theta burst stimulation, we tested cortical excitability measured by the resting motor threshold and motor evoked potential amplitude over the stimulated hemisphere and vasomotor reactivity to CO(2) bilaterally. The blood flow velocity was monitored in both middle cerebral arteries throughout the experimental session. In a separate session, we tested the effects of sham stimulation under the same experimental conditions. Whereas the resting motor threshold remained unchanged before and after stimulation, motor evoked potential amplitudes increased significantly (P = .04). During and after stimulation, middle cerebral artery blood flow velocities also remained bilaterally unchanged, whereas vasomotor reactivity to CO(2) increased bilaterally (P = .04). The sham stimulation left all variables unchanged. The expected intermittent theta burst stimulation-induced changes in cortical excitability were not accompanied by changes in cerebral blood flow velocities; however, the bilateral increased vasomotor reactivity suggests that intermittent theta burst stimulation influences the cerebral microcirculation, possibly involving subcortical structures. These findings provide useful information on hemodynamic phenomena accompanying intermittent theta burst stimulation, which should be considered in research aimed at developing this noninvasive, low-intensity stimulation technique for safe therapeutic applications.

Cerebral vasomotor reactivity: steady-state versus transient changes in carbon dioxide tension

PubMed Central

Brothers, R Matthew; Lucas, Rebekah A I; Zhu, Yong-Sheng; Crandall, Craig G; Zhang, Rong

2014-01-01

New Findings What is the central question of this study? The relationship between changes in cerebral blood flow and arterial carbon dioxide tension is used to assess cerebrovascular function. Hypercapnia is generally evoked by two methods, i.e. steady-state and transient increases in carbon dioxide tension. In some cases, the hypercapnia is immediately preceded by a period of hypocapnia. It is unknown whether the cerebrovascular response differs between these methods and whether a period of hypocapnia blunts the subsequent response to hypercapnia. What is the main finding and its importance? The cerebrovascular response is similar between steady-state and transient hypercapnia. However, hyperventilation-induced hypocapnia attenuates the cerebral vasodilatory responses during a subsequent period of rebreathing-induced hypercapnia. Cerebral vasomotor reactivity (CVMR) to changes in arterial carbon dioxide tension () is assessed during steady-state or transient changes in . This study tested the following two hypotheses: (i) that CVMR during steady-state changes differs from that during transient changes in ; and (ii) that CVMR during rebreathing-induced hypercapnia would be blunted when preceded by a period of hyperventilation. For each hypothesis, end-tidal carbon dioxide tension () middle cerebral artery blood velocity (CBFV), cerebrovascular conductance index (CVCI; CBFV/mean arterial pressure) and CVMR (slope of the linear regression between changes in CBFV and CVCI versus ) were assessed in eight individuals. To address the first hypothesis, measurements were made during the following two conditions (randomized): (i) steady-state increases in of 5 and 10 Torr above baseline; and (ii) rebreathing-induced transient breath-by-breath increases in . The linear regression for CBFV versus (P = 0.65) and CVCI versus (P = 0.44) was similar between methods; however, individual variability in CBFV or CVCI responses existed among subjects. To address the second hypothesis, the same measurements were made during the following two conditions (randomized): (i) immediately following a brief period of hypocapnia induced by hyperventilation for 1 min followed by rebreathing; and (ii) during rebreathing only. The slope of the linear regression for CBFV versus (P < 0.01) and CVCI versus (P < 0.01) was reduced during hyperventilation plus rebreathing relative to rebreathing only. These results indicate that cerebral vasomotor reactivity to changes in is similar regardless of the employed methodology to induce changes in and that hyperventilation-induced hypocapnia attenuates the cerebral vasodilatory responses during a subsequent period of rebreathing-induced hypercapnia. PMID:25172891

Algodystrophy: complex regional pain syndrome and incomplete forms

PubMed Central

Giannotti, Stefano; Bottai, Vanna; Dell’Osso, Giacomo; Bugelli, Giulia; Celli, Fabio; Cazzella, Niki; Guido, Giulio

2016-01-01

Summary The algodystrophy, also known as complex regional pain syndrome (CRPS), is a painful disease characterized by erythema, edema, functional impairment, sensory and vasomotor disturbance. The diagnosis of CRPS is based solely on clinical signs and symptoms, and for exclusion compared to other forms of chronic pain. There is not a specific diagnostic procedure; careful clinical evaluation and additional test should lead to an accurate diagnosis. There are similar forms of chronic pain known as bone marrow edema syndrome, in which is absent the history of trauma or triggering events and the skin dystrophic changes and vasomotor alterations. These incomplete forms are self-limited, and surgical treatment is generally not needed. It is still controversial, if these forms represent a distinct self-limiting entity or an incomplete variant of CRPS. In painful unexplained conditions such as frozen shoulder, post-operative stiff shoulder or painful knee prosthesis, the algodystrophy, especially in its incomplete forms, could represent the cause. PMID:27252736

Vasomotor and physical menopausal symptoms are associated with sleep quality.

PubMed

Kim, Min-Ju; Yim, Gyeyoon; Park, Hyun-Young

2018-01-01

Sleep disturbance is one of the common complaints in menopause. This study investigated the relationship between menopausal symptoms and sleep quality in middle-aged women. This cross-sectional observational study involved 634 women aged 44-56 years attending a healthcare center at Kangbuk Samsung Hospitals. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).Multiple linear regression analysis was performed to assess the associations between Menopause-specific Quality of Life (MENQOL) scores and PSQI scores and Menopause-specific Quality of Life (MENQOL)scores. The mean PSQI score was 3.6±2.3, and the rates of poor sleep quality(PSQI score > 5) in premenopausal, perimenopausal, and postmenopausal women were 14.4%, 18.2%, and 30.2%, respectively. Total PSQI score, specifically the sleep latency, habitual sleep efficiency and sleep disturbances scores, were significantly increased in postmenopausal women. Multiple linear regression analysis adjusted for age, BMI, hypertension, diabetes, smoking, marital status, family income, education, employment status, parity, physical activity, depression symptoms, perceived stress and menopausal status showed that higher PSQI score was positively correlated with higher vasomotor(ß = 0.240, P = 0.020)and physical(ß = 0.572, P<0.001) scores. Vasomotor and physical menopause symptoms was related to poor sleep quality. Effective management strategies aimed at reducing menopausal symptoms may improve sleep quality among women around the time of menopause.

Local Control of Blood Flow

ERIC Educational Resources Information Center

Clifford, Philip S.

2011-01-01

Organ blood flow is determined by perfusion pressure and vasomotor tone in the resistance vessels of the organ. Local factors that regulate vasomotor tone include myogenic and metabolic autoregulation, flow-mediated and conducted responses, and vasoactive substances released from red blood cells. The relative importance of each of these factors…

Coronary vasomotor abnormalities in insulin-resistant individuals.

PubMed

Quiñones, Manuel J; Hernandez-Pampaloni, Miguel; Schelbert, Heinrich; Bulnes-Enriquez, Isabel; Jimenez, Xochitl; Hernandez, Gustavo; De La Rosa, Roxana; Chon, Yun; Yang, Huiying; Nicholas, Susanne B; Modilevsky, Tamara; Yu, Katherine; Van Herle, Katja; Castellani, Lawrence W; Elashoff, Robert; Hsueh, Willa A

2004-05-04

Insulin resistance is a metabolic spectrum that progresses from hyperinsulinemia to the metabolic syndrome, impaired glucose tolerance, and finally type 2 diabetes mellitus. It is unclear when vascular abnormalities begin in this spectrum of metabolic effects. To evaluate the association of insulin resistance with the presence and reversibility of coronary vasomotor abnormalities in young adults at low cardiovascular risk. Cross-sectional study followed by prospective, open-label treatment study. University hospital. 50 insulin-resistant and 22 insulin-sensitive, age-matched Mexican-American participants without glucose intolerance or traditional risk factors for or evidence of coronary artery disease. 3 months of thiazolidinedione therapy for 25 insulin-resistant patients. Glucose infusion rate in response to insulin infusion was used to define insulin resistance (glucose infusion rate < or = 4.00 mg/kg of body weight per minute [range, 0.90 to 3.96 mg/kg per minute]) and insulin sensitivity (glucose infusion rate > or = 7.50 mg/kg per minute [range, 7.52 to 13.92 mg/kg per minute]). Myocardial blood flow was measured by using positron emission tomography at rest, during cold pressor test (largely endothelium-dependent), and after dipyridamole administration (largely vascular smooth muscle-dependent). Myocardial blood flow responses to dipyridamole were similar in the insulin-sensitive and insulin-resistant groups. However, myocardial blood flow response to cold pressor test increased by 47.6% from resting values in insulin-sensitive patients and by 14.4% in insulin-resistant patients. During thiazolidinedione therapy in a subgroup of insulin-resistant patients, insulin sensitivity improved, fasting plasma insulin levels decreased, and myocardial blood flow responses to cold pressor test normalized. The study was not randomized, and it included only 1 ethnic group. Insulin-resistant patients who do not have hypercholesterolemia or hypertension and do not smoke manifest coronary vasomotor abnormalities. Insulin-sensitizing thiazolidinedione therapy normalized these abnormalities. These results suggest an association between insulin resistance and abnormal coronary vasomotor function, a relationship that requires confirmation in larger studies.

[Atopic eczema: psychophysiological reactivity with standardized stressors].

PubMed

Münzel, K; Schandry, R

1990-11-01

In 18 atopic eczema patients with active symptomatology and 15 control subjects a comparison of reactivity to psychological stressors was made. The physiological measures were heart rate, peripheral vasomotor response, skin resistance level, spontaneous fluctuations of the skin resistance, and forearm skin temperature. In addition, self-ratings of subjective state, situational anxiety, and social anxiety were assessed. Mental arithmetic performed undisturbed and in distracting conditions, and anticipation of the latter and of having to speak in public served as stressors. The results show higher reaction values of the eczema patients for heart rate, peripheral vasomotor response, fluctuations of skin resistance and subjective tension. A subgroup of patients with extreme skin irritation (itching) reacted with an elevation of skin temperature, in contrast to control subjects and patients with less marked itching, in whom skin temperature dropped slightly. The results suggest that atopic eczema may have a psychophysiological component.

Treatment-associated musculoskeletal and vasomotor symptoms and relapse-free survival in the NCIC CTG MA.27 adjuvant breast cancer aromatase inhibitor trial.

PubMed

Stearns, Vered; Chapman, Judith-Anne W; Ma, Cynthia X; Ellis, Matthew J; Ingle, James N; Pritchard, Kathleen I; Budd, G Thomas; Rabaglio, Manuela; Sledge, George W; Le Maitre, Aurélie; Kundapur, Jessica; Liedke, Pedro E R; Shepherd, Lois E; Goss, Paul E

2015-01-20

Treatment-emergent symptoms with adjuvant tamoxifen and aromatase inhibitors (AIs) have been associated with superior recurrence-free survival (RFS). We hypothesized that MA.27 anastrozole- or exemestane-treated patients with new or worsening vasomotor and/or joint symptoms would have improved RFS. MA.27 randomly assigned 7,576 postmenopausal women with breast cancer to 5 years of anastrozole or exemestane. Patient-reported symptoms were collected using the Common Terminology Criteria for Adverse Events version 3.0 at protocol-specified baseline and 6- and 12-month clinical visits. Symptoms were considered present with either vasomotor and/or joint complaints. Associations between symptoms and baseline patient characteristics were examined with χ(2) and Fisher's exact tests. Subsequent effects of new or worsening symptoms on RFS were examined with landmark analyses and stratified univariable and multivariable Cox models. We examined the effects of 3-month symptoms arising from unplanned clinic visits as a result of severe toxicity. Patients were assessable if eligible for the MA.27 trial, received some trial therapy, and had no disease recurrence at the end of a symptom assessment period; 96% of patients (n = 7,306 patients) were included at 6 months, and 96% (n = 7,246) were included at 12 months. Thirty-four percent of patients had baseline symptoms. For patients without baseline symptoms, 25% and 52% had new symptoms by 6 and 12 months, respectively. Neither treatment-emergent nor baseline symptoms significantly impacted RFS (P > .10) in patients with or without baseline symptoms. In MA.27, anastrozole or exemestane treatment-emergent symptoms were not associated with improved RFS. Women should be supported through treatment and encouraged to remain on their AI regardless of their symptoms. © 2014 by American Society of Clinical Oncology.

Androgens and menopause.

PubMed

Shulman, L P

2009-12-01

The cessation of ovarian sex steroidigenesis, either as result as surgical extirpation, certain medical therapies or the gradual cessation of ovarian function, leads to menopause with all its associated physiological, physical and lifestyle changes. The changing hormonal milieu of menopause is most commonly associated with declining levels of estrogens. However, ovarian senescence also results in declining levels of androgens. Indeed, it is the loss of physiological levels of estrogens and androgens that result in the varied signs and symptoms of menopause including vasomotor symptoms, bone mineral density loss, reduced interest in sex, alterations in mood and energy and hair loss, among others. This paper will provide a review of the role of androgens in the menopause and assess the potential of androgen therapies in the management of the menopause.

Skin vasomotor hemiparesis followed by overactivity: characteristic thermography findings in a patient with Horner syndrome due to spinal cord infarction.

PubMed

Kobayashi, Makoto

2016-04-01

We present a 21-year-old female with Horner syndrome due to spinal cord infarction. In this patient, infrared thermography revealed a hemibody skin temperature increase followed by excessive focal decreases, indicating skin vasomotor hemiparesis and overactivity.

Chronic resveratrol enhances endothelium-dependent relaxation but does not alter eNOS levels in aorta of spontaneously hypertensive rats.

PubMed

Rush, James W E; Quadrilatero, Joe; Levy, Andrew S; Ford, Rebecca J

2007-06-01

Spontaneously hypertensive rats (SHRs) were administered the red wine polyphenol resveratrol in drinking water at 0, 0.448, or 4.48 mg/l (control, low, or high, respectively) for 28 days. The low dosage was chosen to mimic moderate red wine consumption. After the treatment period, thoracic aorta rings were excised for in vitro assessment of vasomotor function. Chronic resveratrol significantly improved endothelium-dependent relaxation to acetylcholine (Ach), increasing maximal values to 80.8% +/- 5.2% and 80.8% +/- 5.0% in low and high groups, respectively, compared with 60.7% +/- 1.4% in controls (P<0.01). This treatment effect was eliminated in the presence of the endothelial nitric oxide synthase (eNOS) blocker N(omega)-nitro-L-arginine methyl ester. Resveratrol did not affect relaxation to sodium nitroprusside or systolic blood pressure in SHRs. In contrast to the SHR results, chronic resveratrol in Sprague Dawley rats did not affect vasomotor function in aorta rings in response to Ach. Hydrogen peroxide was reduced in the SHR thoracic aorta by a high dosage of resveratrol (P<0.05), but it was not significantly altered in other tissues tested. Thoracic aorta immunoblots revealed no significant treatment effects in SHRs on eNOS, superoxide dismutases 1 and 2, gp91phox, or Hsp90. Thus, these data provide novel evidence of improved endothelium-dependent vasorelaxation in hypertensive, but not normotensive, animals as a result of chronic resveratrol consumption mimicking dosages resulting from moderate red wine consumption. This response was not dependent on increases in eNOS expression but was dependent on improved NO bioavailability.

Vasomotor Symptoms Monitoring with a Commercial Activity Tracking Watch

DTIC Science & Technology

2017-12-31

volunteers wearing physiological monitors. The study protocol and written consent form were...available, but similar devices with EDA/GSR sensors are available. Vasomotor symptoms started disrupting the sleep of a woman volunteer on...November 23, 2015, calling attention to their occurrence. After November 23, 2015, the volunteer started personally logging the occurrence of

EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms.

PubMed

Mintziori, Gesthimani; Lambrinoudaki, Irene; Goulis, Dimitrios G; Ceausu, Iuliana; Depypere, Herman; Erel, C Tamer; Pérez-López, Faustino R; Schenck-Gustafsson, Karin; Simoncini, Tommaso; Tremollieres, Florence; Rees, Margaret

2015-07-01

To review non-hormonal therapy options for menopausal vasomotor symptoms. The current EMAS position paper aims to provide to provide guidance for managing peri- and postmenopausal women who cannot or do not wish to take menopausal hormone therapy (MHT). Literature review and consensus of expert opinion. Non-hormonal management of menopausal symptoms includes lifestyle modifications, diet and food supplements, non-hormonal medications and application of behavioral and alternative medicine therapies. There is insufficient or conflicting evidence to suggest that exercise, supplements or a diet rich in phytoestrogens are effective for vasomotor menopausal symptoms. Selective serotonin-reuptake inhibitors (SSRIs), serotonin norepinephrine-reuptake inhibitors (SNRIs) and gabapentin could be proposed as alternatives to MHT for menopausal symptoms, mainly hot flushes. Behavioral therapies and alternative medicine interventions have been tried, but the available evidence is still limited. A number of interventions for non-hormonal management of menopausal vasomotor symptoms are now available. For women who cannot or do not wish to take estrogens, non-hormonal management is now a realistic option. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effect of wood smoke exposure on vascular function and thrombus formation in healthy fire fighters.

PubMed

Hunter, Amanda L; Unosson, Jon; Bosson, Jenny A; Langrish, Jeremy P; Pourazar, Jamshid; Raftis, Jennifer B; Miller, Mark R; Lucking, Andrew J; Boman, Christoffer; Nyström, Robin; Donaldson, Kenneth; Flapan, Andrew D; Shah, Anoop S V; Pung, Louis; Sadiktsis, Ioannis; Masala, Silvia; Westerholm, Roger; Sandström, Thomas; Blomberg, Anders; Newby, David E; Mills, Nicholas L

2014-12-09

Myocardial infarction is the leading cause of death in fire fighters and has been linked with exposure to air pollution and fire suppression duties. We therefore investigated the effects of wood smoke exposure on vascular vasomotor and fibrinolytic function, and thrombus formation in healthy fire fighters. In a double-blind randomized cross-over study, 16 healthy male fire fighters were exposed to wood smoke (~1 mg/m³ particulate matter concentration) or filtered air for one hour during intermittent exercise. Arterial pressure and stiffness were measured before and immediately after exposure, and forearm blood flow was measured during intra-brachial infusion of endothelium-dependent and -independent vasodilators 4-6 hours after exposure. Thrombus formation was assessed using the ex vivo Badimon chamber at 2 hours, and platelet activation was measured using flow cytometry for up to 24 hours after the exposure. Compared to filtered air, exposure to wood smoke increased blood carboxyhaemoglobin concentrations (1.3% versus 0.8%; P < 0.001), but had no effect on arterial pressure, augmentation index or pulse wave velocity (P > 0.05 for all). Whilst there was a dose-dependent increase in forearm blood flow with each vasodilator (P < 0.01 for all), there were no differences in blood flow responses to acetylcholine, sodium nitroprusside or verapamil between exposures (P > 0.05 for all). Following exposure to wood smoke, vasodilatation to bradykinin increased (P = 0.003), but there was no effect on bradykinin-induced tissue-plasminogen activator release, thrombus area or markers of platelet activation (P > 0.05 for all). Wood smoke exposure does not impair vascular vasomotor or fibrinolytic function, or increase thrombus formation in fire fighters. Acute cardiovascular events following fire suppression may be precipitated by exposure to other air pollutants or through other mechanisms, such as strenuous physical exertion and dehydration.

The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study.

PubMed

Garcia, Marcelo C; Kozasa, Elisa H; Tufik, Sergio; Mello, Luiz Eugênio A M; Hachul, Helena

2018-05-21

The aim of the study was to evaluate the effects of mindfulness and relaxation training for insomnia on insomnia and quality of life in postmenopausal women. Thirty postmenopausal women aged 50 to 65 years, who were not using hormone therapy, and had a diagnosis of insomnia and an apnea-hypopnea index of less than 15, were randomly assigned to two groups: a mindfulness intervention group and a control group. They were assessed before the intervention, and 8 weeks after its completion using questionnaires assessing sleep quality (Pittsburgh Sleep Quality Index), insomnia (Insomnia Severity Index), quality of life in menopause (Menopause-Specific Quality of Life), menopausal symptoms (Kupperman Menopausal Index), and level of attention (Mindfulness Awareness Attention Scale). They were also assessed through ambulatory polysomnography. This is a pilot study and is limited by its small sample size. The results of the questionnaires showed significant differences in the group that received mindfulness training compared with the control group, namely, improvements in sleep quality, a reduction in the severity of insomnia, a better quality of life, improved attention levels, and a reduction in menopausal and vasomotor symptoms. Polysomnography results showed no differences between the groups. Eight weeks mindfulness meditation training improved sleep quality, quality of life, attention levels, and reduced vasomotor symptoms in postmenopausal women with insomnia.

Dissociation of metabolic and hemodynamic levodopa responses in the 6-hydroxydopamine rat model.

PubMed

Lerner, Renata P; Bimpisidis, Zisis; Agorastos, Stergiani; Scherrer, Sandra; Dewey, Stephen L; Cenci, M Angela; Eidelberg, David

2016-12-01

Dissociation of vasomotor and metabolic responses to levodopa has been observed in human subjects with Parkinson's disease (PD) studied with PET and in autoradiograms from 6-hydroxydopamine (6-OHDA) rat. In both species, acute levodopa administration was associated with increases in basal ganglia cerebral blood flow (CBF) with concurrent reductions in cerebral metabolic rate (CMR) for glucose in the same brain regions. In this study, we used a novel dual-tracer microPET technique to measure CBF and CMR levodopa responses in the same animal. Rats with unilateral 6-OHDA or sham lesion underwent sequential 15 O-water (H 2 15 O) and 18 F-fluorodeoxyglucose (FDG) microPET to map CBF and CMR following the injection of levodopa or saline. A subset of animals was separately scanned under ketamine/xylazine and isoflurane to compare the effects of these anesthetics. Regardless of anesthetic agent, 6-OHDA animals exhibited significant dissociation of vasomotor (ΔCBF) and metabolic (ΔCMR) responses to levodopa, with stereotyped increases in CBF and reductions in CMR in the basal ganglia ipsilateral to the dopamine lesion. No significant changes were seen in sham-lesioned animals. These data faithfully recapitulate analogous dissociation effects observed previously in human PD subjects scanned sequentially during levodopa infusion. This approach may have utility in the assessment of new drugs targeting the exaggerated regional vasomotor responses seen in human PD and in experimental models of levodopa-induced dyskinesia. Copyright © 2016 Elsevier Inc. All rights reserved.

Progression of leprosy neuropathy: a case series study

PubMed Central

Vital, Robson T; Illarramendi, Ximena; Nascimento, Osvaldo; Hacker, Mariana A; Sarno, Euzenir N; Jardim, Marcia R

2012-01-01

A need still exists to determine the clinical and neurophysiological characteristics of leprosy neuropathy at distinct times of the disease by different methods that measure the various nerve fiber functions. A prospective clinical study was performed with 10 paucibacillary (PB) and 12 multibacillary (MB) patients evaluated at diagnosis and one year after cessation of multidrug therapy (MDT). Peripheral nerve function was assessed clinically and by means of the sympathetic skin response, skin vasomotor reflex, and nerve conduction study (NCS). At diagnosis, 73% of the total 22 patients had nerve function impairment (NFI). Autonomic function (χ2= 5.5, P= 0.019) and NCS (χ2= 7.765, P= 0.01) were significantly more altered in MB than PB patients. At final evaluation, NFI of the MB patients had worsened, especially among the six who had leprosy reaction. As the NFI of PB patients showed improvement, a significant difference between the two groups (χ2= 12.320, P= 0.001) was observed. A high prevalence of neuropathy was observed in newly diagnosed patients. Associating different tests with a thorough clinical neurological evaluation increases detection rates. PMID:22741099

Thermoregulation in intense microwave fields

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michaelson, S.M.

1981-10-01

These studies clearly indicate the thermoregulatory capacity of the dog to withstand exposure to high microwave fields at specific absorption rates (SAR) of 3.7 and 6.1 W/kg. It appears that adequate thermoregulation takes place at an SAR of 3.7 W/kg but only transiently at 6.1 W/kg. These values, compared with the standardized resting metabolic rate of 3.29 W/kg (0.75), provide a basis for assessing the relationship of the thermal burden and thermo-regulatory disruption by microwaves in the dog. To elucidate the thermal potential of microwave exposure, it was helpful to conduct these exposures at various ambient temperatures in which themore » normal body temperature remained stable, thus permitting comparison of heat production and dissipation with our without microwaves. The zone of the thermal neutrality or thermoneutral zone of vasomotor activity, 22-26.5 deg C, where body temperature is regulated by changes in vasomotor tonus, fulfilled this requirement.« less

Hot flushes in women with breast cancer: state of the art and future perspectives.

PubMed

Barba, Maddalena; Pizzuti, Laura; Sergi, Domenico; Maugeri-Saccà, Marcello; Vincenzoni, Cristina; Conti, Francesca; Tomao, Federica; Vizza, Enrico; Di Lauro, Luigi; Di Filippo, Franco; Carpano, Silvia; Mariani, Luciano; Vici, Patrizia

2014-02-01

Although not life-threatening, vasomotor symptoms might have a detrimental effect on quality of life and represent a major determinant of poor therapeutic compliance in breast cancer patients. Limitations of hormonal therapies have fostered the use of non-estrogenic pharmacological agents, which mainly include centrally acting compounds, antidepressant drugs, serotonin-norepinephrine reuptake inhibitors and serotonin reuptake inhibitors. Integrating therapeutic tools have recently come from a wide range of heterogeneous approaches varying from phytoestrogens use to ganglion block. We herein critically review the most updated evidence on the available treatment options for management of vasomotor symptoms. The need for a patient-oriented approach following systematic evaluation of the presence and degree of vasomotor disturbances is also discussed and future perspectives in therapeutics are summarized.

Short-term administration of progesterone and estradiol independently alter carotid-vasomotor, but not carotid-cardiac, baroreflex function in young women.

PubMed

Brunt, Vienna E; Miner, Jennifer A; Kaplan, Paul F; Halliwill, John R; Strycker, Lisa A; Minson, Christopher T

2013-10-01

The individual effects of estrogen and progesterone on baroreflex function remain poorly understood. We sought to determine how estradiol (E2) and progesterone (P4) independently alter the carotid-cardiac and carotid-vasomotor baroreflexes in young women by using a hormone suppression and exogenous add-back design. Thirty-two young women were divided into two groups and studied under three conditions: 1) after 4 days of endogenous hormone suppression with a gonadotropin releasing hormone antagonist (control condition), 2) after continued suppression and 3 to 4 days of supplementation with either 200 mg/day oral progesterone (N = 16) or 0.1 to 0.2 mg/day transdermal 17β-estradiol (N = 16), and 3) after continued suppression and 3 to 4 days of supplementation with both hormones. Changes in heart rate (HR), mean arterial pressure (MAP), and femoral vascular conductance (FVC) were measured in response to 5 s of +50 mmHg external neck pressure to unload the carotid baroreceptors. Significant hormone effects on the change in HR, MAP, and FVC from baseline at the onset of neck pressure were determined using mixed model covariate analyses accounting for P4 and E2 plasma concentrations. Neither P4 (P = 0.95) nor E2 (P = 0.95) affected the HR response to neck pressure. Higher P4 concentrations were associated with an attenuated fall in FVC (P = 0.01), whereas higher E2 concentrations were associated with an augmented fall in FVC (P = 0.02). Higher E2 was also associated with an augmented rise in MAP (P = 0.01). We conclude that progesterone blunts whereas estradiol enhances carotid-vasomotor baroreflex sensitivity, perhaps explaining why no differences in sympathetic baroreflex sensitivity are commonly reported between low and high combined hormone phases of the menstrual cycle.

Short-term administration of progesterone and estradiol independently alter carotid-vasomotor, but not carotid-cardiac, baroreflex function in young women

PubMed Central

Brunt, Vienna E.; Miner, Jennifer A.; Kaplan, Paul F.; Halliwill, John R.; Strycker, Lisa A.

2013-01-01

The individual effects of estrogen and progesterone on baroreflex function remain poorly understood. We sought to determine how estradiol (E2) and progesterone (P4) independently alter the carotid-cardiac and carotid-vasomotor baroreflexes in young women by using a hormone suppression and exogenous add-back design. Thirty-two young women were divided into two groups and studied under three conditions: 1) after 4 days of endogenous hormone suppression with a gonadotropin releasing hormone antagonist (control condition), 2) after continued suppression and 3 to 4 days of supplementation with either 200 mg/day oral progesterone (N = 16) or 0.1 to 0.2 mg/day transdermal 17β-estradiol (N = 16), and 3) after continued suppression and 3 to 4 days of supplementation with both hormones. Changes in heart rate (HR), mean arterial pressure (MAP), and femoral vascular conductance (FVC) were measured in response to 5 s of +50 mmHg external neck pressure to unload the carotid baroreceptors. Significant hormone effects on the change in HR, MAP, and FVC from baseline at the onset of neck pressure were determined using mixed model covariate analyses accounting for P4 and E2 plasma concentrations. Neither P4 (P = 0.95) nor E2 (P = 0.95) affected the HR response to neck pressure. Higher P4 concentrations were associated with an attenuated fall in FVC (P = 0.01), whereas higher E2 concentrations were associated with an augmented fall in FVC (P = 0.02). Higher E2 was also associated with an augmented rise in MAP (P = 0.01). We conclude that progesterone blunts whereas estradiol enhances carotid-vasomotor baroreflex sensitivity, perhaps explaining why no differences in sympathetic baroreflex sensitivity are commonly reported between low and high combined hormone phases of the menstrual cycle. PMID:23873800

Diurnal and nocturnal skin temperature regulation in chronic complex regional pain syndrome.

PubMed

Schilder, Johanna C M; Niehof, Sjoerd P; Marinus, Johan; van Hilten, Jacobus J

2015-03-01

Skin temperature changes due to vasomotor disturbances are important features of complex regional pain syndrome (CRPS). Because this phenomenon has only been studied under controlled conditions, information on daily circadian variability is lacking. Also, studies in chronic CRPS patients with abnormal posturing, in which coldness of the affected extremity is more common, do not exist. We examined the response to external heating as well as circadian temperature changes over several days in the affected legs of 14 chronic CRPS patients with abnormal posturing and 17 controls. Skin temperatures were recorded hourly for 14 days using wireless sensors. Although the patients' affected extremities were significantly colder before external heating, the vasodilatory response was similar in the 2 groups. Additionally, median skin temperature differences between both legs and their variability was larger in patients than in controls during the day, but not during the night. These findings indicate that the mechanisms underlying impaired skin circulation in CRPS during daytime are reversible under certain circumstances. The large variation in skin temperature differences during the day questions the validity of using a single measurement in the diagnosis of CRPS, and our results indicate that only temperature differences >1.0 °C should be considered to reflect vasomotor disturbances. This article shows that chronic CRPS patients have a normal vasodilatory response to external heating and that skin temperature differences between the affected and unaffected lower limbs, which were highly variable during daytime, disappeared during sleep. This indicates that part of the vasomotor regulation in these patients is still functional. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS): A cohort profile.

PubMed

Faubion, Stephanie S; Kapoor, Ekta; Kling, Juliana M; Kuhle, Carol L; Sood, Richa; Rullo, Jordan E; Thielen, Jacqueline M; Shuster, Lynne T; Rocca, Walter A; Hilsaca, Karla S Frohmader; Mara, Kristin C; Schroeder, Darrell R; Miller, Virginia M

2018-01-01

The Women's Health Clinic (WHC) at Mayo Clinic in Rochester, Minnesota, has provided consultative care to women with menopausal and sexual health concerns since 2005. Clinical information on the 8688 women seen in the WHC through May 2017 who gave consent for the use of their medical records in research is contained in the Data Registry on Experiences of Aging, Menopause, and Sexuality (DREAMS). Initially, DREAMS was created to improve the clinical care of women, but it has become a valuable research tool. About 25% of the DREAMS women have been seen in the WHC 2 or more times, allowing for passive longitudinal follow-up. Additionally, about 25% of the DREAMS women live in the 27-county region included in the expanded Rochester Epidemiology Project medical records linkage system, providing additional information on those women. The cohort has been used to investigate associations between: caffeine intake and vasomotor symptom bother; recent abuse (physical, sexual, verbal, and emotional) and menopausal symptoms; specific menopausal symptoms and self-reported view of menopause; and obstructive sleep apnea risk and vasomotor symptom severity and the experience of vasomotor symptoms in women older than 60 years. A study nearing completion describes a clinical series of over 3500 women presenting for sexual health consultation by sexual function domain and by decade of life. Other studies under way are determining correlates with sexual health and dysfunction. Planned studies will investigate associations between the experience with menopause and the risk of disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Symptoms of endocrine treatment and outcome in the BIG 1-98 study.

PubMed

Huober, J; Cole, B F; Rabaglio, M; Giobbie-Hurder, A; Wu, J; Ejlertsen, B; Bonnefoi, H; Forbes, J F; Neven, P; Láng, I; Smith, I; Wardley, A; Price, K N; Goldhirsch, A; Coates, A S; Colleoni, M; Gelber, R D; Thürlimann, B

2014-01-01

There may be a relationship between the incidence of vasomotor and arthralgia/myalgia symptoms and treatment outcomes for postmenopausal breast cancer patients with endocrine-responsive disease who received adjuvant letrozole or tamoxifen. Data on patients randomized into the monotherapy arms of the BIG 1-98 clinical trial who did not have either vasomotor or arthralgia/myalgia/carpal tunnel (AMC) symptoms reported at baseline, started protocol treatment and were alive and disease-free at the 3-month landmark (n = 4,798) and at the 12-month landmark (n = 4,682) were used for this report. Cohorts of patients with vasomotor symptoms, AMC symptoms, neither, or both were defined at both 3 and 12 months from randomization. Landmark analyses were performed for disease-free survival (DFS) and for breast cancer free interval (BCFI), using regression analysis to estimate hazard ratios (HR) and 95 % confidence intervals (CI). Median follow-up was 7.0 years. Reporting of AMC symptoms was associated with better outcome for both the 3- and 12-month landmark analyses [e.g., 12-month landmark, HR (95 % CI) for DFS = 0.65 (0.49-0.87), and for BCFI = 0.70 (0.49-0.99)]. By contrast, reporting of vasomotor symptoms was less clearly associated with DFS [12-month DFS HR (95 % CI) = 0.82 (0.70-0.96)] and BCFI (12-month DFS HR (95 % CI) = 0.97 (0.80-1.18). Interaction tests indicated no effect of treatment group on associations between symptoms and outcomes. While reporting of AMC symptoms was clearly associated with better DFS and BCFI, the association between vasomotor symptoms and outcome was less clear, especially with respect to breast cancer-related events.

Prevalence and severity of menopause symptoms and associated factors across menopause status in Korean women.

PubMed

Yim, Gyeyoon; Ahn, Younjhin; Chang, Yoosoo; Ryu, Seungho; Lim, Joong-Yeon; Kang, Danbee; Choi, Eun-Kyung; Ahn, Jiin; Choi, Yuni; Cho, Juhee; Park, Hyun-Young

2015-10-01

The present study investigated the prevalence and severity of menopause symptoms experienced by Korean women aged 44 to 56 years and their associated factors. A cross-sectional study was performed on 2,201 women aged 44 to 56 years in health checkup centers between November 2012 and March 2013. The 29-item Menopause-Specific Quality of Life Questionnaire was used to assess vasomotor, psychosocial, physical, and sexual symptoms related to menopause. The guidelines for the classification of reproductive aging stages proposed at the Stages of Reproductive Aging Workshop were used. Multivariable linear regression analyses were performed to identify factors associated with severity of menopause symptoms. Among participants, 42.6% were premenopausal, 36.7% were perimenopausal, and 20.7% were postmenopausal. Although physical symptoms were the most severe menopause symptoms experienced by premenopausal and perimenopausal women, postmenopausal women reported sexual symptoms as the most bothersome. The mean scores for each domain increased from the premenopausal period through the postmenopausal period (P for trend < 0.001). The regression model revealed that age (for vasomotor and sexual symptoms) and obesity (for vasomotor and physical symptoms) were significantly associated with severity of menopause symptoms (P < 0.05). Physically active women had fewer severe physical symptoms related to menopause than inactive women. Postmenopausal women experience the most severe symptoms. Obesity and physical activity are the main modifiable factors associated with symptom severity. Further studies are needed to examine the effects of physical activity promotion and weight control interventions on preventing menopause symptoms in Korean women.

Haemodynamic changes in ipsilateral and contralateral fingers caused by acute exposures to hand transmitted vibration.

PubMed Central

Bovenzi, M; Griffin, M J

1997-01-01

OBJECTIVES: To investigate changes in digital circulation during and after exposure to hand transmitted vibration. By studying two frequencies and two magnitudes of vibration, to investigate the extent to which haemodynamic changes depend on the vibration frequency, the vibration acceleration, and the vibration velocity. METHODS: Finger skin temperature (FST), finger blood flow (FBF), and finger systolic pressure were measured in the fingers of both hands in eight healthy men. Indices of digital vasomotor tone-such as critical closing pressure and vascular resistance-were estimated by pressure-flow curves obtained with different hand heights. With a static load of 10 N, the right hand was exposed for 30 minutes to each of the following root mean squared (rms) acceleration magnitudes and frequencies of vertical vibration: 22 m.s-2 at 31.5 Hz, 22 m.s-2 at 125 Hz, and 87 m.s-2 at 125 Hz. A control condition consisted of exposure to the static load only. The measures of digital circulation and vasomotor tone were taken before exposure to the vibration and the static load, and at 0, 20, 40, and 60 minutes after the end of each exposure. RESULTS: Exposure to static load caused no significant changes in FST, FBF, or indices of vasomotor tone in either the vibrated right middle finger or the non-vibrated left middle finger. In both fingers, exposure to vibration of 125 Hz and 22 m.s-2 produced a greater reduction in FBF and a greater increase in vasomotor tone than did vibration of 31.5 Hz and 22 m.s-2. In the vibrated right finger, exposure to vibration of 125 Hz and 87 m.s-2 provoked an immediate vasodilation which was followed by vasoconstriction during recovery. The non-vibrated left finger showed a significant increase in vasomotor tone throughout the 60 minute period after the end of vibration exposure. CONCLUSIONS: The digital circulatory response to acute vibration depends upon the magnitude and frequency of the vibration stimulus. Vasomotor mechanisms, mediated both centrally and locally, are involved in the reaction of digital vessels to acute vibration. The pattern of the haemodynamic changes in the fingers exposed to the vibration frequencies used in this study do not seem to support the frequency weighting assumed in the current international standard ISO 5349. PMID:9326160

PTEN, a negative regulator of PI3K/Akt signaling, sustains brain stem cardiovascular regulation during mevinphos intoxication.

PubMed

Tsai, Ching-Yi; Wu, Jacqueline C C; Fang, Chi; Chang, Alice Y W

2017-09-01

Activation of PI3K/Akt signaling, leading to upregulation of nitric oxide synthase II (NOS II)/peroxynitrite cascade in the rostral ventrolateral medulla (RVLM), the brain stem site that maintains blood pressure and sympathetic vasomotor tone, underpins cardiovascular depression induced by the organophosphate pesticide mevinphos. By exhibiting dual-specificity protein- and lipid-phosphatase activity, phosphatase and tensin homolog (PTEN) directly antagonizes the PI3K/Akt signaling by dephosphorylation of phosphatidylinositol-3,4,5-trisphosphate, the lipid product of PI3K. Based on the guiding hypothesis that PTEN may sustain brain stem cardiovascular regulation during mevinphos intoxication as a negative regulator of PI3K/Akt signaling in the RVLM, we aimed in this study to clarify the mechanistic role of PTEN in mevinphos-induced circulatory depression. Microinjection bilaterally of mevinphos (10 nmol) into the RVLM of anesthetized Sprague-Dawley rats induced a progressive hypotension and a decrease in baroreflex-mediated sympathetic vasomotor tone. There was progressive augmentation in PTEN activity as reflected by a decrease in the oxidized form of PTEN in the RVLM during mevinhpos intoxication, without significant changes in the mRNA or protein level of PTEN. Loss-of-function manipulations of PTEN in the RVLM by immunoneutralization, pharmacological blockade or siRNA pretreatment significantly potentiated the increase in Akt activity or NOS II/peroxynitrite cascade in the RVLM, enhanced the elicited hypotension and exacerbated the already reduced baroreflex-mediated sympathetic vasomotor tone. We conclude that augmented PTEN activity via a decrease of its oxidized form in the RVLM sustains brain stem cardiovascular regulation during mevinphos intoxication via downregulation of the NOS II/peroxynitrite cascade as a negative regulator of PI3K/Akt signaling. Copyright © 2017 Elsevier Ltd. All rights reserved.

Activation of PI3K/Akt signaling in rostral ventrolateral medulla impairs brain stem cardiovascular regulation that underpins circulatory depression during mevinphos intoxication.

PubMed

Tsai, Ching-Yi; Chang, Alice Y W; Chan, Julie Y H; Chan, Samuel H H

2014-03-01

As the most widely used pesticides in the globe, the organophosphate compounds are understandably linked with the highest incidence of suicidal poisoning. Whereas the elicited toxicity is often associated with circulatory depression, the underlying mechanisms require further delineation. Employing the pesticide mevinphos as our experimental tool, we evaluated the hypothesis that transcriptional upregulation of nitric oxide synthase II (NOS II) by NF-κB on activation of the PI3K/Akt cascade in the rostral ventrolateral medulla (RVLM), the brain stem site that maintains blood pressure and sympathetic vasomotor tone, underpins the circulatory depressive effects of organophosphate poisons. Microinjection of mevinphos (10 nmol) bilaterally into the RVLM of anesthetized Sprague-Dawley rats induced a progressive hypotension that was accompanied sequentially by an increase (Phase I) and a decrease (Phase II) of an experimental index for the baroreflex-mediated sympathetic vasomotor tone. There were also progressive augmentations in PI3K or Akt enzyme activity and phosphorylation of p85 or Akt(Thr308) subunit in the RVLM that were causally related to an increase in NF-κB transcription activity and elevation in NOS II or peroxynitrite expression. Loss-of-function manipulations of PI3K or Akt in the RVLM significantly antagonized the reduced baroreflex-mediated sympathetic vasomotor tone and hypotension during Phase II mevinphos intoxication, and blunted the increase in NF-κB/NOS II/peroxynitrite signaling. We conclude that activation of the PI3K/Akt cascade, leading to upregulation of NF-κB/NOS II/peroxynitrite signaling in the RVLM, elicits impairment of brain stem cardiovascular regulation that underpins circulatory depression during mevinphos intoxication. Copyright © 2014 Elsevier Inc. All rights reserved.

Relationship between changes in vasomotor symptoms and changes in menopause-specific quality of life and sleep parameters.

PubMed

Pinkerton, JoAnn V; Abraham, Lucy; Bushmakin, Andrew G; Cappelleri, Joseph C; Komm, Barry S

2016-10-01

This study characterizes and quantifies the relationship of vasomotor symptoms (VMS) of menopause with menopause-specific quality of life (MSQOL) and sleep parameters to help predict treatment outcomes and inform treatment decision-making. Data were derived from a 12-week randomized, double-blind, placebo-controlled phase 3 trial that evaluated effects of two doses of conjugated estrogens/bazedoxifene on VMS in nonhysterectomized postmenopausal women (N = 318, mean age = 53.39) experiencing at least seven moderate to severe hot flushes (HFs) per day or at least 50 per week. Repeated measures models were used to determine relationships between HF frequency and severity and outcomes on the Menopause-Specific Quality of Life questionnaire and the Medical Outcomes Study sleep scale. Sensitivity analyses were performed to check assumptions of linearity between VMS and outcomes. Frequency and severity of HFs showed approximately linear relationships with MSQOL and sleep parameters. Sensitivity analyses supported assumptions of linearity. The largest changes associated with a reduction of five HFs and a 0.5-point decrease in severity occurred in the Menopause-Specific Quality of Life vasomotor functioning domain (0.78 for number of HFs and 0.98 for severity) and the Medical Outcomes Study sleep disturbance (7.38 and 4.86) and sleep adequacy (-5.60 and -4.66) domains and the two overall sleep problems indices (SPI: 5.17 and 3.63; SPII: 5.82 and 3.83). Frequency and severity of HFs have an approximately linear relationship with MSQOL and sleep parameters-that is, improvements in HFs are associated with improvements in MSQOL and sleep. Such relationships may enable clinicians to predict changes in sleep and MSQOL expected from various VMS treatments.

Evaluation of cerebral vasomotor reactivity in Parkinson's disease: is there any association with orthostatic hypotension?

PubMed

Zamani, Babak; Mehrabani, Mehrnoush; Fereshtehnejad, Seyed-Mohammad; Rohani, Mohammad

2011-06-01

Our aim was to look for a probable relationship between cerebral vasomotor reactivity (VMR) and orthostatic hypotension (OH) in Parkinson's disease (PD). This study was conducted on 44 patients with PD. Assessment of cerebral VMR was performed by means of transcranial Doppler (TCD) of middle cerebral artery (MCA) before and after a vasodilatory stimulus, carbon dioxide test. Moreover, orthostatic hypotension was evaluated. OH was presented in 12 (27.3%) Parkinson's patients. The average resting blood flow velocity (BFV) in the MCA was 30.20 (SD=9.58)cms(-1) which significantly increased to 46.25 (SD=16.23)cms(-1) after carbon dioxide test (P<0.001). Impaired VMR was observed in 15 (34.1%) of the subjects, while it was not associated with the presence of OH (P=0.770). Evaluation of VMR in patients affected by PD, could assist in early diagnosis of cerebral autonomic dysfunction and prevent its serious consequences prior and more valid to OH. Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.

Endothelium and Its Alterations in Cardiovascular Diseases: Life Style Intervention

PubMed Central

Paganelli, Corrado; Buffoli, Barbara; Rodella, Luigi Fabrizio; Rezzani, Rita

2014-01-01

The endothelium, which forms the inner cellular lining of blood vessels and lymphatics, is a highly metabolically active organ that is involved in many physiopathological processes, including the control of vasomotor tone, barrier function, leukocyte adhesion, and trafficking and inflammation. In this review, we summarized and described the following: (i) endothelial cell function in physiological conditions and (ii) endothelial cell activation and dysfunction in the main cardiovascular diseases (such as atherosclerosis, and hypertension) and to diabetes, cigarette smoking, and aging physiological process. Finally, we presented the currently available evidence that supports the beneficial effects of physical activity and various dietary compounds on endothelial functions. PMID:24719887

Safety of veralipride for the treatment of vasomotor symptoms of menopause.

PubMed

Valencia, Marcelino Hernández; Arias, María de Jesús Vega; González, Cuauhtémoc Celis; Marín, Imelda Hernández; González, Juan Humberto Martín; Campos, Enrique Rafael Morcate; Rodríguez, María Antonia Basavilvazo; Álvarez, Ignacio Morales; Vargas, María Antonia Valdés; Flores, José Braulio Everardo Otero; Haro, Samuel Santoyo; Bonilla, Manuel Cortes; Escudero, Roberto Bernardo; Campero, Rosalba Alonso

2014-05-01

Veralipride is a nonhormonal option for the treatment of vasomotor symptoms of menopause. Incidence of adverse events in a Mexican population and drug compliance according to correct use were evaluated. We carried out a longitudinal, prospective, and analytical study in Mexican women who received veralipride to treat symptoms of menopause from 2011 to 2012. There were 386 treatment cycles; 272 were assigned to dosing schedule 1, which included 20 days of treatment with 10 days of suspension, and 114 were assigned to dosing schedule 2, which included 5 days of treatment and 2 days of suspension. A total of 57 adverse events were registered during the 386-month treatment. For the 20 × 10 dosing schedule, the highest incidence was observed for anxiety (2.2%), drowsiness, and weakness (1.5%); for the 5 × 2 dosing schedule, the highest incidence was observed for drowsiness (5.3%) and headache (2.6%). The Hamilton Depression Rating Scale was used to assess the presence and severity of depression; improvement was noted. The Unified Parkinson's Disease Rating Scale was used to assess neurological movement disorders; no adverse neurological events were detected. Based on the assessments of both women and physicians, the highest frequency was observed for "very satisfied" (45.5% and 52.3%, respectively), followed by "satisfied" (23.9% and 27.3%, respectively). Both dosing schedules show acceptable safety profiles for up to 6 months of use when used according to the contraindications in the current prescribing information for standard use (2012) and recent medical literature.

Cutaneous sensory and autonomic denervation in CADASIL.

PubMed

Nolano, Maria; Provitera, Vincenzo; Donadio, Vincenzo; Caporaso, Giuseppe; Stancanelli, Annamaria; Califano, Francesca; Pianese, Luigi; Liguori, Rocco; Santoro, Lucio; Ragno, Michele

2016-03-15

To assess the involvement of the peripheral nervous system in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) by means of immunofluorescence and confocal analysis of punch skin biopsies. We recruited 14 unrelated patients with CADASIL (M/F = 9/5; age 53.9 ± 10.5 years) and 52 healthy controls (M/F = 31/21; age 53.8 ± 9.8). Patients underwent clinical and neuroradiologic assessment. Three-millimeter punch skin biopsies were taken from the fingertip, the thigh, and the distal leg and processed using indirect immunofluorescence and a panel of primary antibodies to mark vessels and sensory and autonomic nerve fibers. Intraepidermal nerve fibers (IENF), Meissner corpuscles (MC), and sudomotor, vasomotor, and pilomotor nerves were assessed using confocal microscopy. In patients, compared to controls, we found a severe loss of IENF at the distal leg (p < 0.01), at the thigh (p < 0.01), and at the fingertip (p < 0.01) with a non-length-dependent pattern and a loss of MC (p < 0.01). A severe sudomotor, vasomotor, and pilomotor nerve fiber loss was found by semiquantitative evaluation. Along with nerve loss, a severe derangement of the vascular bed was observed. In our patient population, sensory and autonomic denervation did not correlate with age, sex, type of mutation, or MRI involvement. We found an involvement of the peripheral nervous system in patients with CADASIL through the assessment of cutaneous somatic and autonomic nerves. The neurovascular derangement observed in the skin may reflect, although to a lesser extent, what happens in the CNS. © 2016 American Academy of Neurology.

Contemporary approaches to modulating the nitric oxide-cGMP pathway in cardiovascular disease

PubMed Central

Kraehling, Jan R.; Sessa, William C.

2017-01-01

Endothelial cells lining the vessel wall control important aspects of vascular homeostasis. In particular, the production of endothelium-derived nitric oxide and activation of soluble guanylate cyclase promotes endothelial quiescence and governs vasomotor function and proportional remodeling of blood vessels. Here, we discuss novel approaches to improve endothelial nitric oxide generation and preserve its bioavailability. We also discuss therapeutic opportunities aimed at activation of soluble guanylate cyclase for multiple cardiovascular indications. PMID:28360348

Sudomotor and vasomotor activity during the menstrual cycle with global heating.

PubMed

Petrofsky, Jerrold; Lee, Haneul; Khowailed, Iman Akef

2017-07-01

Many studies have reported that there are changes in sympathetic activity throughout the menstrual cycle as there are oestrogen receptor in the hypothalamus and all other parts of the sympathetic nervous system. The purpose of this study was to see whether there were variations in sympathetic activity, skin vasomotor and sweat gland sudomotor rhythms during the menstrual cycle. Eight young female subjects with a regular menstrual cycle participated in the study. Subjects were tested once during the follicular phase and once during the luteal phase. Skin blood flow and sweat rate were significantly higher in the luteal phase compared with the follicular phase (p < .05), but the frequency and magnitude of sudomotor and vasomotor rhythms were significantly greater in the follicular phase (p < .05). In contrast, spectral data showed less sympathetic activity in the luteal phase. A significant finding here is that the sudomotor rhythm of sweat glands is altered by the menstrual cycle. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Association between aerobic fitness and cerebrovascular function with neurocognitive functions in healthy, young adults.

PubMed

Hwang, Jungyun; Kim, Kiyoung; Brothers, R Matthew; Castelli, Darla M; Gonzalez-Lima, F

2018-05-01

Studies of the effects of physical activity on cognition suggest that aerobic fitness can improve cognitive abilities. However, the physiological mechanisms for the cognitive benefit of aerobic fitness are less well understood. We examined the association between aerobic fitness and cerebrovascular function with neurocognitive functions in healthy, young adults. Participants aged 18-29 years underwent measurements of cerebral vasomotor reactivity (CVMR) in response to rebreathing-induced hypercapnia, maximal oxygen uptake (VO 2 max) during cycle ergometry to voluntary exhaustion, and simple- and complex-neurocognitive assessments at rest. Ten subjects were identified as having low-aerobic fitness (LF < 15th fitness percentile), and twelve subjects were identified as having high-aerobic fitness (HF > 80th fitness percentile). There were no LF versus HF group differences in cerebrovascular hemodynamics during the baseline condition. Changes in middle cerebral artery blood velocity and CVMR during hypercapnia were elevated more in the HF than the LF group. Compared to the LF, the HF performed better on a complex-cognitive task assessing fluid reasoning, but not on simple attentional abilities. Statistical modeling showed that measures of VO 2 max, CVMR, and fluid reasoning were positively inter-correlated. The relationship between VO 2 max and fluid reasoning, however, did not appear to be reliably mediated by CVMR. In conclusion, a high capacity for maximal oxygen uptake among healthy, young adults was associated with greater CVMR and better fluid reasoning, implying that high-aerobic fitness may promote cerebrovascular and cognitive functioning abilities.

Cerebral vasomotor reactivity: steady-state versus transient changes in carbon dioxide tension.

PubMed

Brothers, R Matthew; Lucas, Rebekah A I; Zhu, Yong-Sheng; Crandall, Craig G; Zhang, Rong

2014-11-01

Cerebral vasomotor reactivity (CVMR) to changes in arterial carbon dioxide tension (P aCO 2) is assessed during steady-state or transient changes in P aCO 2. This study tested the following two hypotheses: (i) that CVMR during steady-state changes differs from that during transient changes in P aCO 2; and (ii) that CVMR during rebreathing-induced hypercapnia would be blunted when preceded by a period of hyperventilation. For each hypothesis, end-tidal carbon dioxide tension (P ET , CO 2) middle cerebral artery blood velocity (CBFV), cerebrovascular conductance index (CVCI; CBFV/mean arterial pressure) and CVMR (slope of the linear regression between changes in CBFV and CVCI versus P ET , CO 2) were assessed in eight individuals. To address the first hypothesis, measurements were made during the following two conditions (randomized): (i) steady-state increases in P ET , CO 2 of 5 and 10 Torr above baseline; and (ii) rebreathing-induced transient breath-by-breath increases in P ET , CO 2. The linear regression for CBFV versus P ET , CO 2 (P = 0.65) and CVCI versus P ET , CO 2 (P = 0.44) was similar between methods; however, individual variability in CBFV or CVCI responses existed among subjects. To address the second hypothesis, the same measurements were made during the following two conditions (randomized): (i) immediately following a brief period of hypocapnia induced by hyperventilation for 1 min followed by rebreathing; and (ii) during rebreathing only. The slope of the linear regression for CBFV versus P ET , CO 2 (P < 0.01) and CVCI versus P ET , CO 2 (P < 0.01) was reduced during hyperventilation plus rebreathing relative to rebreathing only. These results indicate that cerebral vasomotor reactivity to changes in P aCO 2 is similar regardless of the employed methodology to induce changes in P aCO 2 and that hyperventilation-induced hypocapnia attenuates the cerebral vasodilatory responses during a subsequent period of rebreathing-induced hypercapnia. © 2014 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.

Pravastatin and endothelium dependent vasomotion after coronary angioplasty: the PREFACE trial.

PubMed

Mulder, H J; Schalij, M J; Kauer, B; Visser, R F; van Dijkman, P R; Jukema, J W; Zwinderman, A H; Bruschke, A V

2001-11-01

To test the hypothesis that the 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor pravastatin ameliorates endothelium mediated responses of dilated coronary segments: the PREFACE (pravastatin related effects following angioplasty on coronary endothelium) trial. A double blind, randomised, placebo controlled, multicentre study. Four hospitals in the Netherlands. 63 non-smoking, non-hypercholesterolaemic patients scheduled for elective balloon angioplasty (pravastatin 34, placebo 29). The effects of three months of pravastatin treatment (40 mg daily) on endothelium dependent vasomotor function were studied. Balloon angioplasty was undertaken one month after randomisation, and coronary vasomotor function tests using acetylcholine were performed two months after balloon angioplasty. The angiograms were analysed quantitatively. The efficacy measure was the acetylcholine induced change in mean arterial diameter, determined in the dilated segment and in an angiographically normal segment of an adjacent non-manipulated coronary artery. Increasing acetylcholine doses produced vasoconstriction in the dilated segments (p = 0.004) but not in the normal segments. Pravastatin did not affect the vascular response to acetylcholine in either the dilated segments (p = 0.09) or the non-dilated sites. Endothelium dependent vasomotion in normal segments was correlated with that in dilated segments (r = 0.47, p < 0.001). There were fewer procedure related events in the pravastatin group than in the placebo group (p < 0.05). Endothelium dependent vasomotion in normal segments is correlated with that in dilated segments. A significant beneficial effect of pravastatin on endothelial function could not be shown, but in the dilated segments there was a trend towards a beneficial treatment effect in the pravastatin group.

Effects of raloxifene on cognition, mental health, sleep and sexual function in menopausal women: a systematic review of randomized controlled trials.

PubMed

Yang, Z D; Yu, J; Zhang, Q

2013-08-01

Raloxifene has been used as therapy for osteoporosis and ER(+) breast cancer prevention in menopausal women. However, its effects on cognition and climacteric syndrome are controversial. This study reviews the relevant studies and reaches a comprehensive conclusion. We retrieved thirteen electronic databases, read the titles and abstracts to exclude ineligible articles, and then read the full text and references to form a basis for decisions using the inclusion criteria. If full text was not available, we asked the author for a copy of the article. After the data were extracted and recorded, the research quality was evaluated by two authors using the Jadad score and Cochrane handbook. We found seven eligible studies. The design, evaluated items, questionnaires and scales were heterogeneous. The design quality was fair as evaluated by the Cochrane Handbook. We found that 60 mg/day raloxifene could improve verbal memory, and 120 mg/day raloxifene produced a 33% decrease in the risk of mild cognitive impairment and also lowered the risk of Alzheimer's disease. There was not enough evidence to state if raloxifene had any effect on depression, anxiety, sleep, sexual function, vasomotor symptoms, but significantly worsened menstrual symptoms. Raloxifene may have some benefit for cognition, but it is not significant effect on anxiety, depression, sleep, sexual function, vasomotor symptoms and worsens menstrual symptoms. This drug is safe for treating osteoporosis and preventing breast cancer in menopausal women, but it is not suitable for patients who have any arterial stenosis or thrombophilia. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

Contemporary Approaches to Modulating the Nitric Oxide-cGMP Pathway in Cardiovascular Disease.

PubMed

Kraehling, Jan R; Sessa, William C

2017-03-31

Endothelial cells lining the vessel wall control important aspects of vascular homeostasis. In particular, the production of endothelium-derived nitric oxide and activation of soluble guanylate cyclase promotes endothelial quiescence and governs vasomotor function and proportional remodeling of blood vessels. Here, we discuss novel approaches to improve endothelial nitric oxide generation and preserve its bioavailability. We also discuss therapeutic opportunities aimed at activation of soluble guanylate cyclase for multiple cardiovascular indications. © 2017 American Heart Association, Inc.

Psychophysical and Vasomotor Responses of the Oral Tissues: A Nicotine Dose-Response and Menthol Interaction Study.

PubMed

Arendt Nielsen, Thomas; Nielsen, Bruno Provstgaard; Wang, Kelun; Arendt-Nielsen, Lars; Boudreau, Shellie A

2016-05-01

This study implemented an intra-oral test-platform to assess the sensory, psychophysical, and vasomotor responses to nicotine and menthol, alone or in combination. Two double-blinded, placebo-controlled, randomized, cross-over studies, including healthy nonsmoking participants were performed. Study I: A dose-response relationship (N = 20) between 0, 2, and 4 mg nicotine gum. Study II: An interaction response (N = 22) to 30 mg menthol and 4 mg nicotine alone or in combination. Heart rate, blood pressure, tactile and thermosensory thresholds, intra-oral blood flow and temperature, pain/irritation intensities/locations, McGill Pain Questionnaire, and taste experience were assessed before, during or after the completion of a standardized chewing regime. A dose-response elevation in heart rate was attenuated when nicotine was combined with menthol. Blood flow, temperature, and warm-detection thresholds, as assessed on the tongue, similarly increased for all gums. Pain intensity and taste experiences were similar between nicotine doses. Nicotine attenuated the sweet, cooling, and freshening sensation of menthol. Within the first 4 minutes, menthol reduced the intensity but not the area of nicotine-induced pain and irritation. The 4-mg nicotine dose led to a continued increase in the intensity and area of irritation in the throat post-chewing. Moreover, one-half of participants responded to menthol as an irritant, and these individuals demonstrated larger areas of nicotine-induced irritation in the throat post-chewing. The intra-oral test platform provides a basis to optimize the assessment of nicotine-related taste and sensory experiences and can be used in future studies for profiling nicotine gum. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Presence of young children at home may moderate development of hot flashes during the menopausal transition.

PubMed

Lorenz, Tierney K; McGregor, Bonnie A; Vitzthum, Virginia J

2015-04-01

This work aims to determine the role of child care in hot flashes. Broad differences in vasomotor symptom experience are observed among perimenopausal women across cultures. Women in cultures where contact with young children is common report significantly fewer and less severe hot flashes than women in cultures where older women spend less time around children. Could these differences be related to the presence of young children? We surveyed 117 healthy women undergoing prophylactic bilateral oophorectomy (removal of both ovaries to reduce the risk of gynecologic cancers). Participants provided demographic information, including pre-surgical operation menopause status and number of children (younger than 13 y, 13-17 y, and 18 y or older) living at home. They were surveyed for menopausal symptoms 2 weeks before surgical operation and at 2 months, 6 months, and 1 year after surgical operation. Women who were premenopausal at the time of surgical operation experienced a significant increase in vasomotor symptoms. Within this group, participants with young children at home reported significantly fewer vasomotor symptoms across time than did women who did not live with young children. Women who were already menopausal at the time of surgical operation who had young children at home reported more vasomotor symptoms before surgical operation than did those without young children; however, this effect did not remain significant across follow-ups. These findings suggest that interactions with young children may mitigate hot flashes in women undergoing surgical menopause. These findings may be used to counsel women who are considering prophylactic oophorectomy about the likelihood of menopausal symptoms.

Cardioactive and vasoactive effects of natural wild honey against cardiac malperformance induced by hyperadrenergic activity.

PubMed

Rakha, Miran K; Nabil, Zohour I; Hussein, Aida A

2008-03-01

Induction of hyperadrenergic activity was experimentally achieved in urethane-anesthetized rats using epinephrine (adrenaline). Acute administration of epinephrine (100 microg/kg) for 2 hours induced several cardiac disorders and vasomotor dysfunction. Pretreatment with natural wild honey (5 g/kg) for 1 hour prior to the injection with epinephrine (100 mug/kg) protected the anesthetized normal rats from the incidence of epinephrine-induced cardiac disorders and vasomotor dysfunction. Moreover, posttreatment with natural wild honey (5 g/kg) following the injection with epinephrine (100 microg/kg) for 1 hour showed several ameliorative outcomes to the electrocardiographic parameters and vasomotor dysfunction of anesthetized stressed rats. Furthermore, natural wild honey preserved the positive inotropic effect of epinephrine in both cases. Also, the total antioxidant capacity (AOC) of natural wild honey was found to be very pronounced. Levels of both reduced glutathione and ascorbic acid (vitamin C) were considered relatively high in natural wild honey. Activity of superoxide dismutase (SOD) was also high, whereas catalase activity was relatively low, especially when compared to the value of SOD activity. It would appear from the results of the present study that natural wild honey may exert its cardioprotective and therapeutic effects against epinephrine-induced cardiac disorders and vasomotor dysfunction directly, via its very pronounced total AOC and its great wealth of both enzymatic and nonenzymatic antioxidants involved in cardiovascular defense mechanisms, besides its substantial quantities of mineral elements such as magnesium, sodium, and chlorine, and/or indirectly, via the enhancement of the endothelium-derived relaxing factor nitric oxide release through the influence of ascorbic acid (vitamin C).

The effect of foot reflexology applied to women aged between 40 and 60 on vasomotor complaints and quality of life.

PubMed

Gozuyesil, Ebru; Baser, Muruvvet

2016-08-01

This study aims to identify the effects of foot reflexology applied to women on their vasomotor complaints and quality of life. A randomised controlled study was conducted with 120 women. The experimental group received foot reflexology treatment, while the control group received nonspecific foot massage. The mean scores for hot flashes, sweats, and night sweats, were lower in the reflexology group than the control group after the practice; and the difference between the groups was statistically significant (p < 0.001). The mean scores for the sub-groups of the MENQOL demonstrated improvements in both groups after the application (p < 0.001). As for the sexual domain, there was a significant improvement in the reflexology group (p < 0.05), but no improvements were found in the control group (p > 0.05). Results showed that reflexology might be effective in decreasing vasomotor problems and increasing quality of life in women in the menopausal period. Copyright © 2016 Elsevier Ltd. All rights reserved.

What causes hot flushes? The neuroendocrine origin of vasomotor symptoms in the menopause.

PubMed

Rossmanith, Winfried G; Ruebberdt, Wiebke

2009-05-01

Vasomotor symptoms (VMS) such as hot flushes and night sweats are frequently encountered during menopause and can greatly reduce the quality of life. These symptoms are causally related to decreasing estradiol concentrations, mainly in the serum and subsequently also in the hypothalamic temperature regulating centre. The lack of estrogens alters neurotransmitter activity, especially in the serotonergic and noradrenergic pathways. Because sex steroids act as potent neuromodulators, the substitution of ovarian sex steroids by hormone replacement therapy is the most effective treatment option for VMS. When contraindications exist for the use of sex steroids, steroid-free drugs are a possible alternative. A better understanding of the physiology of thermoregulation, thermoregulatory dysfunction and adaptive processes of the brain may facilitate the development of new therapeutic approaches. Such drugs could then be used to treat vasomotor disorders even when the use of steroid hormones is contraindicated. This review article summarises our knowledge on the mechanisms of temperature regulation and describes deviations from this regulation during altered sex steroid conditions. Our current knowledge on neuroendocrinology of thermoregulation may serve as a basis for the use of steroid-free pharmacological intervention.

The thermoregulatory effects of noradrenaline, serotonin and carbachol injected into the rat spinal subarachnoid space.

PubMed

Lopachin, R M; Rudy, T A

1982-12-01

1. We have examined the effects on thermoregulation in the rat of noradrenaline bitartrate (NA), 5-hydroxytryptamine hydrochloride (5-HT) and carbamylcholine chloride (CCh) injected into the lumbar spinal subarachnoid space via a chronic indwelling catheter.2. Intrathecal injections of the monoamines and CCh reproducibly affected thermoregulation, whereas injections of control solutions had no effect.3. Intrathecal injections of NA (0.01-0.30 mumol) produced a dose-dependent hypothermia associated with a decrease in tail skin vasomotor tone. Shivering activity was not depressed during the hypothermia and sometimes increased. Intrathecal administration of the alpha-adrenergic agonist clonidine (0.0175-0.070 mumol) elicited changes in T(c) and T(sk) similar to those induced by intrathecal NA.4. Intrathecal 5-HT (0.030-0.90 mumol) elicited a dose-dependent hyperthermia accompanied by increased tail skin vasomotor tone and increased shivering.5. CCh injected intrathecally (0.001-0.06 mumol) evoked a dose-dependent hyperthermia. During the period when core temperature was rising, tail skin vasomotor tone increased and shivering-like activity was present. Once the maximum core temperature had been reached, tail skin vasodilatation occurred. Vasodilatation persisted until core temperature had returned to normal.6. Intravenous injections of 5-HT (0.30 and 0.90 mumol) or CCh (0.006 and 0.03 mumol) caused no thermoregulatory effect. The effects of these agents injected intrathecally were therefore not due to an action in the periphery.7. Intravenous infusions of NA (0.06 and 0.10 mumol) produced hypothermia and transient tail skin vasodilatation. We suggest that an action at peripheral sites may have contributed to the effects produced by intrathecal injection of this monamine.8. These findings suggest that spinal noradrenergic, serotonergic and cholinergic synapses may be importantly involved in the control of body temperature in the rat. The possible functional roles of these synapses and the putative spinal sites of action of the injected substances are discussed.

Cerebral blood flow velocity and vasomotor reactivity before and after shunting surgery in patients with normal pressure hydrocephalus.

PubMed

Lee, E J; Hung, Y C; Chang, C H; Pai, M C; Chen, H H

1998-01-01

The purpose of this study was to evaluate pre- and post-shunting haemodynamic changes and their correlation with the clinical results in normal pressure hydrocephalus (NPH). Accordingly, eleven demented patients with clinical signs suggestive of NPH received examinations of cerebral blood flow velocity (BFV) and vasomotor reactivity (VMR) by transcranial Doppler sonography with carbogen testing before and after shunt treatment. Computerized tomography (CT), clinical assessment and neuropsychological grading were performed prior to and at 3 months following surgery. A control group consisting of 10 patients was included to establish baseline data. The pre-operative CBF studies in the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) revealed the NPH patients did not have significant decreases of BFVs, but had significant decreases of carbogen VMR (P < 0.05). After shunting, there were no significant changes of the BFVs as compared with the pre-shunting data. The post-shunting VMR of the ACA was significantly higher than the pre-shunting one (p < 0.05), but there was no variation in that of the MCA. Both the values of post-shunting VMR in ACA and the post-shunting increase in VMR in MCA of the 7 shunt-responsive patients who improved mentally and in other symptoms were significantly higher than those of patients without improvement (p < 0.05). In addition, the five patients with gait improvement showed significantly higher values of post-shunting VMR of ACA and the post-shunting increase of VMR for both ACA and MCA when compared with those patients without gait improvement (p < 0.05, respectively). Our study supports the view that patients with NPH had various degrees of impaired VMR in both the ACA and the MCA, but showed insignificant reduction in BFVs, indicating a compensatory mechanism of CBF over time to accommodate the subnormal state of cerebral perfusion pressure. Shunt placement would improve the VMR in responsive patients. Postoperatively, an increase of VMR tends to accompany improvement of the functional state: that in the MCA alone is associated with symptomatic improvement in mental function and that increase in VMR in both the ACA and the MCA with improvement in gait, respectively.

Vasomotor and Related Menopause Symptoms.

PubMed

Stuenkel, Cynthia A

2018-05-31

Vasomotor symptoms are the most common manifestation of the menopause transition and postmenopausal phases of reproductive life. They interfere not only in quality of life, but also contribute to sleep and mood disturbances that potentially compromise home and work effectiveness. Treatment options include hormone therapy (HT), nonhormonal prescription drugs, mind body and behavior therapies, and over-the-counter preparations. Evidence confirms that HT is the most effective option. The initial reticence to prescribe HT immediately following publication of the Women's Health Initiative has been replaced by clear guidelines for confidently identifying women for whom this therapy will be safe.

Transcranial Doppler assessment of cerebral vasomotor reactivity in evaluating the effects of vinpocetine in cerebral small vessel disease: a pilot study.

PubMed

Jovanović, Zagorka B; Pavlović, Aleksandra M; Pekmezović, Tatjana; Mijajlović, Milija; Covicković, Nadezda Sternić

2013-07-30

There are still dilemmas about the vasodilating effect of vinpocetine, a synthetic ethyl alkaloid vincamine. The method of measuring cerebral vasomotor reactivity (VMR) by transcranial Doppler (TCD) technique before and after administration of the medication was used to estimate the degree of arterioles vasodilatation. The aim of this study was to test of the vasodilating effect of vinpocetine in patients with cerebral small vessel disease (SVD) by measuring cerebral VMR. Thirty patients with SVD were on 3-month-long oral treatment with 15 mg vinpocetine daily. Cerebral VMR was determined by breath holding test. The breath holding index (BHI) was calculated in standard manner and values > 0.69 were considered normal. At the baseline, before treatment (I), BHI, modified Rankin scale (mRS) score, Mini Mental State Examination (MMSE) score were determined. One month later (II) BHI was assessed again, while after 3 months of treatment (III) we analyzed BHI, mRS score and MMSE score. The average age of patients was 61.4 +/- 11.5 years (range 40 to 77 years), 18 (60%) female and 12 (40%) males. Values of BHIs were increased during treatment at the right MCA (I) 1.18 +/- 0.53, (II) 1.26 +/- 0.54, (III) 1.37 +/- 0.41, with statistical significance between I and III measurement (p < 0.05). An increase was noted on the left MCA (I) 1.25 +/- 0.53, (II) 1.31 +/- 0.55 and (III) 1.32 +/- 0.42, but it did not reach statistical significance (p > 0.05). Mean MMSE score significantly increased from baseline 27.4 +/- 2.3 to 28.5 +/- 2.0 after three months of treatment (p < 0.001). Functional status showed a statistically significant improvement with mRS score increasing from 2.1 +/- 1.0 to 1.1 +/- 0.6 (p < 0.001). This pilot study showed that 3-month-long oral treatment with vinpocetine 15 mg daily had tendency to increase BHI, indicating improvement of cerebral VMR. It is possible that higher doses of vinpocetine are needed to achieve substantial increase of VMR.

[Effect of milk product with soy isoflavones on quality of life and bone metabolism in postmenopausal Spanish women: randomized trial].

PubMed

García-Martín, Antonia; Quesada Charneco, Miguel; Alvárez Guisado, Alejandro; Jiménez Moleón, José Juan; Fonollá Joya, Juristo; Muñoz-Torres, Manuel

2012-02-04

To analyze the effects of nutritional intervention with a milk product enriched with soy isoflavones on quality of life and bone metabolism in postmenopausal Spanish women. We performed a double-blind controlled randomized trial in ninety-nine postmenopausal women. Group S women (n=48) were randomized to consume milk product enriched with soy isoflavone (50 mg/day) while group C (n=51) consumed product control for 12 months. Parameters of quality of life (Cervantes scale), markers of bone metabolism and bone mass estimated by ultrasound of the calcaneus (QUS) were evaluated. Overall, there was an improvement in the domains menopause (P=.015) and vasomotor symptoms (P<.001). S group emphasized the assessment of vasomotor symptoms (P=.001) and differed positively from group C in health (P=.019), sex (P=.021) and partner (P=.002). Serum levels TRAP (P<.001) and OPG (P=.007) decreased and concentrations of 25-OH-vitamin D increased (P<.001) without differences between groups. In the assessment of QUS, there was an increase in estimated bone mineral density in group S (P=.040), whereas in group C there were no significant differences. Daily consumption of these milk products increases levels of 25-OH-vitamin D and decreases bone metabolism markers. Additional supplementation with soy isoflavones seems to improve quality of life and bone mass in Spanish postmenopausal women. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Moderate-severely bothersome vasomotor symptoms are associated with lowered psychological general wellbeing in women at midlife.

PubMed

Gartoulla, Pragya; Bell, Robin J; Worsley, Roisin; Davis, Susan R

2015-08-01

The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40-65 years, taking into account socio-demographic and lifestyle factors. This was a cross-sectional survey of 2020 Australian women, aged 40-65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient (β)=-8.17, 95% confidence interval (CI) -10.90 to -5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered (β=-2.80, 95% CI -4.74 to -0.86), obese (β=-5.46, 95% CI -7.24 to -3.68) and a smoker (β=-3.47, 95% CI -6.10 to -0.84). Older age (β=0.29, 95% CI 0.06-0.42) and participation in paid and/or volunteer work (β=2.72, 95% CI 0.61-4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Pravastatin and endothelium dependent vasomotion after coronary angioplasty: the PREFACE trial

PubMed Central

Mulder, H; Schalij, M; Kauer, B; Visser, R; van Dijkman, P R M; Jukema, J; Zwinderman, A; Bruschke, A

2001-01-01

OBJECTIVE—To test the hypothesis that the 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor pravastatin ameliorates endothelium mediated responses of dilated coronary segments: the PREFACE (pravastatin related effects following angioplasty on coronary endothelium) trial.
DESIGN—A double blind, randomised, placebo controlled, multicentre study.
SETTING—Four hospitals in the Netherlands.
PATIENTS—63 non-smoking, non-hypercholesterolaemic patients scheduled for elective balloon angioplasty (pravastatin 34, placebo 29).
INTERVENTIONS—The effects of three months of pravastatin treatment (40 mg daily) on endothelium dependent vasomotor function were studied. Balloon angioplasty was undertaken one month after randomisation, and coronary vasomotor function tests using acetylcholine were performed two months after balloon angioplasty. The angiograms were analysed quantitatively.
MAIN OUTCOME MEASURES—The efficacy measure was the acetylcholine induced change in mean arterial diameter, determined in the dilated segment and in an angiographically normal segment of an adjacent non-manipulated coronary artery.
RESULTS—Increasing acetylcholine doses produced vasoconstriction in the dilated segments (p = 0.004) but not in the normal segments. Pravastatin did not affect the vascular response to acetylcholine in either the dilated segments (p = 0.09) or the non-dilated sites. Endothelium dependent vasomotion in normal segments was correlated with that in dilated segments (r = 0.47, p < 0.001). There were fewer procedure related events in the pravastatin group than in the placebo group (p < 0.05).
CONCLUSIONS—Endothelium dependent vasomotion in normal segments is correlated with that in dilated segments. A significant beneficial effect of pravastatin on endothelial function could not be shown, but in the dilated segments there was a trend towards a beneficial treatment effect in the pravastatin group.


Keywords: angioplasty; endothelium; acetylcholine; pravastatin PMID:11602546

Vegans report less bothersome vasomotor and physical menopausal symptoms than omnivores.

PubMed

Beezhold, Bonnie; Radnitz, Cynthia; McGrath, Robert E; Feldman, Arielle

2018-06-01

Lifestyle modifications that may reduce menopausal symptoms have generated much interest. The vegetarian diet has been associated with a lower risk of chronic disease as well as a more healthy hormonal milieu. Our objective in this cross-sectional study was to survey peri- and postmenopausal women to investigate menopausal symptoms and dietary pattern. Survey distribution in 2015-2016 was aimed at female vegans, vegetarians, and omnivores between the ages of 45 and 80 years, who were active on senior and vegetarian social networking websites and at vegan restaurants and events. We investigated vasomotor and physical symptoms as measured by the Menopause-specific Quality of Life Questionnaire (MENQOL) and dietary pattern classified by animal protein intakes reported in response to food frequency questions. Out of 754 participants who completed the survey, 604 reported they were perimenopausal (n = 121) or postmenopausal (n = 483), of whom 539 also completed the food frequency questions. We compared vasomotor and physical symptoms in omnivores (n = 304, consumed meat and/or poultry at least monthly) and vegans (n = 125, abstained from all animal proteins) using general linear models; covariates included age, exercise, hormone replacement therapy, presence of reproductive organs, and age at menopause. Among perimenopausal women, vegans reported less bothersome vasomotor (p < 0.01) and physical symptoms (p < 0.01) than omnivores. For both symptom types, more vegetables and less flesh food were associated with less bothersome symptoms (p values < 0.05). Eating a plant-based diet may be helpful for women in menopausal transition who prefer a natural means to manage their symptoms. Copyright © 2018 Elsevier B.V. All rights reserved.

Acupuncture for the Treatment of Hot Flashes in Patients with Breast Cancer Receiving Antiestrogen Therapy: A Pilot Study in Korean Women

PubMed Central

Jeong, Young Ju; Park, Young Sun; Kwon, Hyo Jung; Shin, Im Hee; Bong, Jin Gu

2013-01-01

Abstract Objectives Antiestrogen therapy can cause vasomotor symptoms similar to those occurring during menopause, including hot flashes. Recent studies suggest that acupuncture is effective in reducing vasomotor symptoms in patients with breast cancer receiving tamoxifen. The purpose of this study was to assess the feasibility and safety of acupuncture for treatment of hot flashes in Korean patients with breast cancer receiving antiestrogen therapy. Design This was a prospective single-arm observational study using before and after measurements. Settings/location The study was located at the East–West Medical Center at Daegu Catholic University Medical Center, Daegu, Korea. Subjects The subjects were 10 patients with breast cancer who were undergoing antiestrogen therapy with tamoxifen or anastrozole and who were suffering from hot flashes. Interventions Acupuncture was administered 3 times a week for 4 consecutive weeks, for 20±5 minutes at each session. Outcome measures The outcome measure was severity of hot flashes assessed by visual analogue scale (VAS) and total hot flash score. Results During treatment, severity of hot flashes was reduced by 70%–95% in all patients. Acupuncture significantly alleviated severity of hot flashes assessed by a visual analogue scale (F=30.261; p<0.001) as well as the total hot flash score (F=21.698; p=0.006). Four (4) weeks after the final treatment, symptoms were not aggravated. Conclusions Acupuncture appeared to provide effective relief from hot flashes among Korean women receiving antiestrogen therapy after surgery for breast cancer, and the effects lasted for at least 1 month after termination of treatment. A randomized controlled prospective study with a larger sample size is required to clarify the role of acupuncture in the management of hot flashes in Korean patients with breast cancer. PMID:23383974

The role of soy foods in the treatment of menopausal symptoms.

PubMed

Levis, Silvina; Griebeler, Marcio L

2010-12-01

The findings of the Women's Health Initiative resulted in a sharp decline in the use of estrogen therapy. Increasingly, menopausal women have been interested in soy foods as an alternative to estrogen therapy for the treatment of menopausal symptoms. This article provides an overview of the limited number of studies that assess the effectiveness of soy foods to alleviate vasomotor and urogenital symptoms. The evidence of the efficacy of soy foods in improving menopausal symptoms is limited due to the small number of trials reporting conflicting results.

Autonomic control of heart rate during orthostasis and the importance of orthostatic-tachycardia in the snake Python molurus.

PubMed

Armelin, Vinicius Araújo; da Silva Braga, Victor Hugo; Abe, Augusto Shinya; Rantin, Francisco Tadeu; Florindo, Luiz Henrique

2014-10-01

Orthostasis dramatically influences the hemodynamics of terrestrial vertebrates, especially large and elongated animals such as snakes. When these animals assume a vertical orientation, gravity tends to reduce venous return, cardiac filling, cardiac output and blood pressure to the anterior regions of the body. The hypotension triggers physiological responses, which generally include vasomotor adjustments and tachycardia to normalize blood pressure. While some studies have focused on understanding the regulation of these vasomotor adjustments in ectothermic vertebrates, little is known about regulation and the importance of heart rate in these animals during orthostasis. We acquired heart rate and carotid pulse pressure (P PC) in pythons in their horizontal position, and during 30 and 60° inclinations while the animals were either untreated (control) or upon muscarinic cholinoceptor blockade and a double autonomic blockade. Double autonomic blockade completely eradicated the orthostatic-tachycardia, and without this adjustment, the P PC reduction caused by the tilts became higher than that which was observed in untreated animals. On the other hand, post-inclinatory vasomotor adjustments appeared to be of negligible importance in counterbalancing the hemodynamic effects of gravity. Finally, calculations of cardiac autonomic tones at each position revealed that the orthostatic-tachycardia is almost completely elicited by a withdrawal of vagal drive.

Vasomotor response of the human face: laser-Doppler measurements during mild hypo- and hyperthermia.

PubMed

Rasch, W; Cabanac, M

1993-04-01

The skin of the face is reputed not to vasoconstrict in response to cold stress because the face skin temperature remains steady during hypothermia. The purpose of the present work was to measure the vasomotor response of the human face to whole-body hypothermia, and to compare it with hyperthermia. Six male subjects were immersed in cold and in warm water to obtain the two conditions. Skin blood flow, evaporation, and skin temperature (Tsk) were recorded in three loci of the face, the forehead, the infra orbital area, and the cheek. Tympanic (Tty) and oesophageal (Toes) temperatures were also recorded during the different thermal states. Normothermic measurements served as control. Blood flow was recorded with a laser-Doppler flowmeter, evaporation measured with an evaporimeter. Face Tsk remained stable between normo-, hypo-, and hyperthermia. Facial blood flow, however, did not follow the same pattern. The facial blood flow remained at minimal vasoconstricted level when the subjects' condition was changed from normo- to hypothermia. When the condition changed from hypo- to hyperthermia a 3 to 9-fold increase in the blood flow was recorded. From these results it was concluded that a vasoconstriction seems to be the general vasomotor state in the face during normothermia.

Defunct brain stem cardiovascular regulation underlies cardiovascular collapse associated with methamphetamine intoxication.

PubMed

Li, Faith C H; Yen, J C; Chan, Samuel H H; Chang, Alice Y W

2012-02-07

Intoxication from the psychostimulant methamphetamine (METH) because of cardiovascular collapse is a common cause of death within the abuse population. For obvious reasons, the heart has been taken as the primary target for this METH-induced toxicity. The demonstration that failure of brain stem cardiovascular regulation, rather than the heart, holds the key to cardiovascular collapse induced by the pesticide mevinphos implicates another potential underlying mechanism. The present study evaluated the hypothesis that METH effects acute cardiovascular depression by dampening the functional integrity of baroreflex via an action on brain stem nuclei that are associated with this homeostatic mechanism. The distribution of METH in brain and heart on intravenous administration in male Sprague-Dawley rats, and the resultant changes in arterial pressure (AP), heart rate (HR) and indices for baroreflex-mediated sympathetic vasomotor tone and cardiac responses were evaluated, alongside survival rate and time. Intravenous administration of METH (12 or 24 mg/kg) resulted in a time-dependent and dose-dependent distribution of the psychostimulant in brain and heart. The distribution of METH to neural substrates associated with brain stem cardiovascular regulation was significantly larger than brain targets for its neurological and psychological effects; the concentration of METH in cardiac tissues was the lowest among all tissues studied. In animals that succumbed to METH, the baroreflex-mediated sympathetic vasomotor tone and cardiac response were defunct, concomitant with cessation of AP and HR. On the other hand, although depressed, those two indices in animals that survived were maintained, alongside sustainable AP and HR. Linear regression analysis further revealed that the degree of dampening of brain stem cardiovascular regulation was positively and significantly correlated with the concentration of METH in key neural substrate involved in this homeostatic mechanism. We conclude that on intravenous administration, METH exhibits a preferential distribution to brain stem nuclei that are associated with cardiovascular regulation. We further found that the concentration of METH in those brain stem sites dictates the extent that baroreflex-mediated sympathetic vasomotor tone and cardiac responses are compromised, which in turn determines survival or fatality because of cardiovascular collapse.

Defunct brain stem cardiovascular regulation underlies cardiovascular collapse associated with methamphetamine intoxication

PubMed Central

2012-01-01

Background Intoxication from the psychostimulant methamphetamine (METH) because of cardiovascular collapse is a common cause of death within the abuse population. For obvious reasons, the heart has been taken as the primary target for this METH-induced toxicity. The demonstration that failure of brain stem cardiovascular regulation, rather than the heart, holds the key to cardiovascular collapse induced by the pesticide mevinphos implicates another potential underlying mechanism. The present study evaluated the hypothesis that METH effects acute cardiovascular depression by dampening the functional integrity of baroreflex via an action on brain stem nuclei that are associated with this homeostatic mechanism. Methods The distribution of METH in brain and heart on intravenous administration in male Sprague-Dawley rats, and the resultant changes in arterial pressure (AP), heart rate (HR) and indices for baroreflex-mediated sympathetic vasomotor tone and cardiac responses were evaluated, alongside survival rate and time. Results Intravenous administration of METH (12 or 24 mg/kg) resulted in a time-dependent and dose-dependent distribution of the psychostimulant in brain and heart. The distribution of METH to neural substrates associated with brain stem cardiovascular regulation was significantly larger than brain targets for its neurological and psychological effects; the concentration of METH in cardiac tissues was the lowest among all tissues studied. In animals that succumbed to METH, the baroreflex-mediated sympathetic vasomotor tone and cardiac response were defunct, concomitant with cessation of AP and HR. On the other hand, although depressed, those two indices in animals that survived were maintained, alongside sustainable AP and HR. Linear regression analysis further revealed that the degree of dampening of brain stem cardiovascular regulation was positively and significantly correlated with the concentration of METH in key neural substrate involved in this homeostatic mechanism. Conclusions We conclude that on intravenous administration, METH exhibits a preferential distribution to brain stem nuclei that are associated with cardiovascular regulation. We further found that the concentration of METH in those brain stem sites dictates the extent that baroreflex-mediated sympathetic vasomotor tone and cardiac responses are compromised, which in turn determines survival or fatality because of cardiovascular collapse. PMID:22313577

Effect of engineered nanoparticles on vasomotor responses in rat intrapulmonary artery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Courtois, Arnaud, E-mail: arnaud.courtois@u-bordeaux2.f; Inserm, U885, Bordeaux, F-33076; Andujar, Pascal

2010-06-01

Pulmonary circulation could be one of the primary vascular targets of finest particles that can deeply penetrate into the lungs after inhalation. We investigated the effects of engineered nanoparticles on vasomotor responses of small intrapulmonary arteries using isometric tension measurements. Acute in vitro exposure to carbon nanoparticles (CNP) decreased, and in some case abolished, the vasomotor responses induced by several vasoactive agents, whereas acute exposure to titanium dioxide nanoparticles (TiO{sub 2}NP) did not. This could be attributed to a decrease in the activity of those vasoactive agents (including PGF{sub 2{alpha}}, serotonin, endothelin-1 and acetylcholine), as suggested when they were exposedmore » to CNP before being applied to arteries. Also, CNP decreased the contraction induced by 30 mM KCl, without decreasing its activity. After endoplasmic reticulum calcium stores depletion (by caffeine and thapsigargin), CaCl{sub 2} addition induced a contraction, dependent on Store-Operated Calcium Channels that was not modified by acute CNP exposure. Further addition of 30 mM KCl elicited a contraction, originating from activation of Voltage-Operated Calcium Channels that was diminished by CNP. Contractile responses to PGF{sub 2{alpha}} or KCl, and relaxation to acetylcholine were modified neither in pulmonary arteries exposed in vitro for prolonged time to CNP or TiO{sub 2}NP, nor in those removed from rats intratracheally instilled with CNP or TiO{sub 2}NP. In conclusion, prolonged in vitro or in vivo exposure to CNP or TiO{sub 2}NP does not affect vasomotor responses of pulmonary arteries. However, acute exposure to CNP decreases contraction mediated by activation of Voltage-Operated, but not Store-Operated, Calcium Channels. Moreover, interaction of some vasoactive agents with CNP decreases their biological activity that might lead to misinterpretation of experimental data.« less

Menopause is associated with self-reported poor sleep quality in women without vasomotor symptoms.

PubMed

Hung, Hao-Chang; Lu, Feng-Hwa; Ou, Horng-Yih; Wu, Jin-Shang; Yang, Yi-Ching; Chang, Chih-Jen

2014-08-01

The aim of this study was to investigate the relationship between menopause and self-reported sleep quality in Chinese women without vasomotor symptoms. Cross-sectional data were collected from a decoded database of the National Cheng Kung University Hospital. Menopause was defined as absence of menses for at least 12 months or a history of hysterectomy and oophorectomy. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer self-reported sleep quality, and a global PSQI score greater than 5 differentiates poor sleepers from good sleepers. Of the 1,088 women recruited, 353 (32.4%) were in postmenopause status. Postmenopausal women had higher mean (SD) global PSQI scores (8.0 [3.3] vs. 6.1 [2.2], P < 0.001) and a greater prevalence of poor sleepers (73.1% vs. 60.8%, P < 0.001) compared with premenopausal women. Multivariate linear regression analysis showed that menopause (β = 1.532; 95% CI, 1.135 to 1.949; P < 0.001) and snoring (β = 0.764; 95% CI, 0.299 to 1.228; P = 0.001) were positively associated with global PSQI scores, whereas long sleep duration (β = -0.791; 95% CI, -1.113 to -0.468; P < 0.001) was negatively associated with global PSQI scores. Multivariate logistic regression analyses showed that menopause (odds ratio, 1.453; 95% CI, 1.030 to 2.051; P < 0.05), long sleep duration (odds ratio, 0.545; 95% CI, 0.418 to 0.710; P < 0.001), and snoring (odds ratio, 2.022; 95% CI, 1.312 to 3.116; P = 0.001) were independent predictors of poor sleepers. Postmenopausal women without vasomotor symptoms have significantly higher global PSQI scores and a higher risk of being poor sleepers than premenopausal women. In addition, menopause and snoring are associated with an increased risk of poor self-reported sleep quality independently of cardiometabolic factors and lifestyle, whereas long sleep duration is associated with a decreased risk of poor self-reported sleep quality.

Effects of botanicals and combined hormone therapy on cognition in postmenopausal women.

PubMed

Maki, Pauline M; Rubin, Leah H; Fornelli, Deanne; Drogos, Lauren; Banuvar, Suzanne; Shulman, Lee P; Geller, Stacie E

2009-01-01

The aim of this study was to characterize the effects of red clover, black cohosh, and combined hormone therapy on cognitive function in comparison to placebo in women with moderate to severe vasomotor symptoms. In a phase II randomized, double-blind, placebo-controlled study, 66 midlife women (of 89 from a parent study; mean age, 53 y) with 35 or more weekly hot flashes were randomized to receive red clover (120 mg), black cohosh (128 mg), 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate (CEE/MPA), or placebo. Participants completed measures of verbal memory (primary outcome) and other cognitive measures (secondary outcomes) before and during the 12th treatment month. A subset of 19 women completed objective, physiological measures of hot flashes using ambulatory skin conductance monitors. Neither of the botanical treatments had an impact on any cognitive measure. Compared with placebo, CEE/MPA led to a greater decline in verbal learning (one of five verbal memory measures). This effect just missed statistical significance (P = 0.057) in unadjusted analyses but reached significance (P = 0.02) after adjusting for vasomotor symptoms. Neither of the botanical treatment groups showed a change in verbal memory that differed from the placebo group (Ps > 0.28), even after controlling for improvements in hot flashes. In secondary outcomes, CEE/MPA led to a decrease in immediate digit recall and an improvement in letter fluency. Only CEE/MPA significantly reduced objective hot flashes. Results indicate that a red clover (phytoestrogen) supplement or black cohosh has no effects on cognitive function. CEE/MPA reduces objective hot flashes but worsens some aspects of verbal memory.

Effects of Botanicals and Combined Hormone Therapy on Cognition in Postmenopausal Women

PubMed Central

Maki, Pauline M.; Rubin, Leah H.; Fornelli, Deanne; Drogos, Lauren; Banuvar, Suzanne; Shulman, Lee P.; Geller, Stacie E.

2009-01-01

Objective To characterize the effects of red clover, black cohosh, and combined hormone therapy on cognitive function in comparison to placebo in women with moderate to severe vasomotor symptoms. Design In a Phase II randomized, double-blind, placebo-controlled study, 66 midlife women (out of 89 from a parent study; mean age=53 y) with ≥ 35 weekly hot flashes were randomized to receive red clover (120 mg), black cohosh (128 mg), CEE/MPA (0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate), or placebo. Participants completed measures of verbal memory (primary outcome) and other cognitive measures (secondary outcomes) before and during the 12th treatment month. A subset of 19 women completed objective, physiological measures of hot flashes using ambulatory skin conductance monitors. Results There was no impact of either of the botanical treatments on any cognitive measure. Compared to placebo, CEE/MPA led to greater decline in verbal learning (one of five verbal memory measures). This effect just missed statistical significance (p=0.057) in unadjusted analyses, but reached significance (p=.02) after adjusting for vasomotor symptoms. Neither botanical treatment group showed a change in verbal memory that differed from the placebo group (ps>0.28), even after controlling for improvements in hot flashes. In secondary outcomes, CEE/MPA led to a decrease in immediate digit recall and an improvement in letter fluency. Only CEE/MPA significantly reduced objective hot flashes. Conclusions Results indicate no effects of a red clover (phytoestrogen) supplement or black cohosh on cognitive function. CEE/MPA reduces objective hot flashes but worsens some aspects of verbal memory. PMID:19590458

Time-frequency analysis of functional optical mammographic images

NASA Astrophysics Data System (ADS)

Barbour, Randall L.; Graber, Harry L.; Schmitz, Christoph H.; Tarantini, Frank; Khoury, Georges; Naar, David J.; Panetta, Thomas F.; Lewis, Theophilus; Pei, Yaling

2003-07-01

We have introduced working technology that provides for time-series imaging of the hemoglobin signal in large tissue structures. In this study we have explored our ability to detect aberrant time-frequency responses of breast vasculature for subjects with Stage II breast cancer at rest and in response to simple provocations. The hypothesis being explored is that time-series imaging will be sensitive to the known structural and functional malformations of the tumor vasculature. Mammographic studies were conducted using an adjustable hemisheric measuring head containing 21 source and 21 detector locations (441 source-detector pairs). Simultaneous dual-wavelength studies were performed at 760 and 830 nm at a framing rate of ~2.7 Hz. Optical measures were performed on women lying prone with the breast hanging in a pendant position. Two class of measures were performed: (1) 20- minute baseline measure wherein the subject was at rest; (2) provocation studies wherein the subject was asked to perform some simple breathing maneuvers. Collected data were analyzed to identify the time-frequency structure and central tendencies of the detector responses and those of the image time series. Imaging data were generated using the Normalized Difference Method (Pei et al., Appl. Opt. 40, 5755-5769, 2001). Results obtained clearly document three classes of anomalies when compared to the normal contralateral breast. 1) Breast tumors exhibit altered oxygen supply/demand imbalance in response to an oxidative challenge (breath hold). 2) The vasomotor response of the tumor vasculature is mainly depressed and exhibits an altered modulation. 3) The affected area of the breast wherein the altered vasomotor signature is seen extends well beyond the limits of the tumor itself.

Advancing age produces sex differences in vasomotor kinetics during and after skeletal muscle contraction.

PubMed

Bearden, Shawn E

2007-09-01

Little is known of the vasomotor responses of skeletal muscle arterioles during and following muscle contraction. We hypothesized that aging leads to impaired arteriolar responses to muscle contraction and recovery. Nitric oxide (NO) availability, which is age dependent, has been implicated in components of these kinetics. Therefore, we also hypothesized that changes in the kinetics of vascular responses are associated with the NO pathway. Groups were young (3 mo), old (24 mo), endothelial NO synthase knockout (eNOS-/-), and N(G)-nitro-L-arginine (L-NA)-treated male and female C57BL/6 mice. The kinetics of vasodilation during and following 1 min of contractions of the gluteus maximus muscle were recorded in second-order (regional distribution) and third-order (local control) arterioles. Baseline, peak (during contraction), and maximal diameters (pharmacological) were not affected by age or sex. The kinetics of dilation and recovery were not different between males and females at the young age. There was a significant slowing of vasodilation at the onset of contractions (approximately 2-fold; P < 0.05) and a significant speeding of recovery ( approximately 5-fold; P < 0.05) in old males vs. old females and vs. young eNOS-/-, and L-NA did not affect the kinetics at the onset of muscle contraction. eNOS-/- mimicked the rapid recovery of old males in second-order arterioles; acute NO production (L-NA) explained approximately 50% of this effect. These data demonstrate fundamental age-related differences between the sexes in the dynamic function of skeletal muscle arterioles. Understanding how youthful function persists in females but not males may provide therapeutic insight into clinical interventions to maintain dynamic microvascular control of nutrient supply with age.

Menopausal symptoms: do life events predict severity of symptoms in peri- and post-menopause?

PubMed

Pimenta, Filipa; Leal, Isabel; Maroco, João; Ramos, Catarina

2012-08-01

Hormonal changes during menopausal transition are linked to physical and psychological symptoms' emergence. This study aims to explore if life events predict menopausal symptoms. This cross-sectional research encompasses a community sample of 992 women who answered to socio-demographic, health, menopause-related and lifestyle questionnaires; menopausal symptoms and life events were assessed with validated instruments. Structural equation modeling was used to build a causal model. Menopausal status predicted only three symptoms: skin/facial hair changes (β=.136; p=.020), sexual (β=.157; p=.004) and, marginally, vasomotor symptoms (β=.094; p=.054). Life events predicted depressive mood (β=-.391; p=.002), anxiety (β=-.271; p=.003), perceived cognitive impairment (β=-.295; p=.003), body shape changes (β=-.136; p=.031), aches/pain (β=-.212; p=.007), skin/facial hair changes (β=-.171; p=.021), numbness (β=-.169; p=.015), perceived loss of control (β=-.234; p=.008), mouth, nails and hair changes (β=-.290; p=.004), vasomotor (β=-.113; p=.044) and sexual symptoms (β=-.208; p=.009). Although women in peri- and post-menopausal manifested higher symptoms' severity than their pre-menopausal counterparts, only three of the menopausal symptoms assessed were predicted by menopausal status. Since the vast majority of menopausal symptoms' severity was significantly influenced by the way women perceived their recent life events, it is concluded that the symptomatology exacerbation, in peri- and post-menopausal women, might be due to life conditions and events, rather than hormonal changes (nonetheless, the inverse influence should be investigated in future studies). Therefore, these should be accounted for in menopause-related clinical and research settings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Female Sexual Function Index Short Version: A MsFLASH Item Response Analysis.

PubMed

Carpenter, Janet S; Jones, Salene M W; Studts, Christina R; Heiman, Julia R; Reed, Susan D; Newton, Katherine M; Guthrie, Katherine A; Larson, Joseph C; Cohen, Lee S; Freeman, Ellen W; Jane Lau, R; Learman, Lee A; Shifren, Jan L

2016-11-01

The Female Sexual Function Index (FSFI) is a psychometrically sound and popular 19-item self-report measure, but its length may preclude its use in studies with multiple outcome measures, especially when sexual function is not a primary endpoint. Only one attempt has been made to create a shorter scale, resulting in the Italian FSFI-6, later translated into Spanish and Korean without further psychometric analysis. Our study evaluated whether a subset of items on the 19-item English-language FSFI would perform as well as the full-length FSFI in peri- and postmenopausal women. We used baseline data from 898 peri- and postmenopausal women recruited from multiple communities, ages 42-62 years, and enrolled in randomized controlled trials for vasomotor symptom management. Goals were to (1) create a psychometrically sound, shorter version of the FSFI for use in peri- and postmenopausal women as a continuous measure and (2) compare it to the Italian FSFI-6. Results indicated that a 9-item scale provided more information than the FSFI-6 across a spectrum of sexual functioning, was able to capture sample variability, and showed sufficient range without floor or ceiling effects. All but one of the items from the Italian 6-item version were included in the 9-item version. Most omitted FSFI items focused on frequency of events or experiences. When assessment of sexual function is a secondary endpoint and subject burden related to questionnaire length is a priority, the 9-item FSFI may provide important information about sexual function in English-speaking peri- and postmenopausal women.

Staging reproductive aging using Stages of Reproductive Aging Workshop + 10 in black urban African women in the Study of Women Entering and in Endocrine Transition.

PubMed

Jaff, Nicole G; Snyman, Tracy; Norris, Shane A; Crowther, Nigel J

2014-11-01

There has been limited research on accurate staging of the menopausal transition in sub-Saharan African women. Our aim was to assess the usefulness of the Stages of Reproductive Aging Workshop + 10 (STRAW + 10) criteria in staging ovarian aging in black South African women, examining whether obesity has any effect on the menopausal transition. The study enrolled 702 women aged 40 to 60 years. STRAW + 10 criteria were used to categorize the stages of reproductive aging. The Menopause Rating Scale was used to measure the prevalence of vasomotor symptoms. Follicle-stimulating hormone (FSH) and estradiol levels were used as supportive criteria for staging. Human immunodeficiency virus status was assessed using a point-of-care method. Reported age at final menstrual period (FMP) was higher in women interviewed within 4 years of FMP (mean [SD], 49.0 [3.80] y) than in women interviewed 10 years or more after FMP (mean [SD], 42.0 [4.06] y; P < 0.0005). In women within 4 years of FMP, lower body mass index was associated with earlier age at FMP. FSH levels increased and estradiol levels decreased (P < 0.0005 for both trends) across seven staging groups. Human immunodeficiency virus status had no effect on menopause symptoms. Obesity (body mass index ≥35.0 kg/m) was associated with severe vasomotor symptoms. Reporting of age at FMP is unreliable in women interviewed 4 years or more after the event. STRAW + 10 seems accurate in staging reproductive aging, as confirmed by the strong association of FSH and estradiol levels with the menopausal transition stage. STRAW + 10 may be appropriate for use in resource-limited settings in the absence of biomarkers. Biocultural methods may be useful in assessing the menopausal transition in culturally diverse women.

Post-Nasal Drip

MedlinePlus

... the interior of the nose with a fiberoptic scope and CAT scan x-rays. If medication does not relieve the problem, surgery may be recommended. Vasomotor Rhinitis describes ... Policy Terms of Use © ...

Chinese herbal medicine for menopausal symptoms

PubMed Central

Zhu, Xiaoshu; Liew, Yuklan; Liu, Zhao Lan

2016-01-01

Background Chinese herbal medicine (CHM) usage is expected to increase as women suffering from menopausal symptoms are seeking alternative therapy due to concerns from the adverse effects (AEs) associated with hormone therapy (HT). Scientific evidence for their effectiveness and safety is needed. Objectives To evaluate the effectiveness and safety of CHM in the treatment of menopausal symptoms. Search methods We searched the Gynaecology and Fertility Group’s Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), MEDLINE, Embase, CINAHL, AMED, and PsycINFO (from inception to March 2015). Others included Current Control Trials, Citation Indexes, conference abstracts in the ISI Web of Knowledge, LILACS database, PubMed, OpenSIGLE database, and China National Knowledge Infrastructure database (CNKI, 1999 to 2015). Other resources included reference lists of articles as well as direct contact with authors. Selection criteria Randomised controlled trials (RCTs) comparing the effectiveness of CHM with placebo, HT, pharmaceutical drugs, acupuncture, or another CHM formula in women over 18 years of age, and suffering from menopausal symptoms. Data collection and analysis Two review authors independently assessed 864 studies for eligibility. Data extractions were performed by them with disagreements resolved through group discussion and clarification of data or direct contact with the study authors. Data analyses were performed in accordance with Cochrane Collaboration guidelines. Main results We included 22 RCTs (2902 women). Participants were from different ethnic backgrounds with the majority of Chinese origin. When CHM was compared with placebo (eight RCTs), there was little or no evidence of a difference between the groups for the following pooled outcomes: hot flushes per day (MD 0.00, 95% CI −0.88 to 0.89; 2 trials, 199 women; moderate quality evidence); hot flushes per day assessed by an overall hot flush score in which a difference of one point equates to one mild hot flush per day (MD −0.81 points, 95% CI −2.08 to 0.45; 3 RCTs, 263 women; low quality evidence); and overall vasomotor symptoms per month measured by the Menopause-Specific Quality of Life questionnaire (MENQOL, scale 0 to 6) (MD −0.42 points; 95% CI −1.52 to 0.68; 3 RCTs, 256 women; low quality evidence). In addition, results from individual studies suggested there was no evidence of a difference between the groups for daily hot flushes assessed by severity (MD −0.70 points, 95% CI −1.00, −0.40; 1 RCT, 108 women; moderate quality evidence); or overall monthly hot flushes scores (MD −2.80 points, 95% CI −8.93 to 3.33; 1 RCT, 84 women; very low quality evidence); or overall daily night sweats scores (MD 0.07 points, 95% CI −0.19 to 0.33, 1 RCT, 64 women; low quality evidence); or overall monthly night sweats scores (MD 1.30 points, 95% CI −1.76 to 4.36, 1 RCT, 84 women; very low quality evidence). However one study using the Kupperman Index reported that overall monthly vasomotor symptom scores were lower in the CHM group (MD −4.79 points, 95% CI −5.52 to −4.06; 1 RCT, 69 women; low quality evidence). When CHM was compared with hormone therapy (HT) (10 RCTs), only two RCTs reported monthly vasomotor symptoms using MENQOL. It was uncertain whether CHM reduces vasomotor symptoms (MD 0.47 points, 95% CI −0.50 to 1.44; 2 RCTs, 127 women; very low quality evidence). Adverse effects were not fully reported in the included studies. Adverse events reported by women taking CHM included mild diarrhoea, breast tenderness, gastric discomfort and an unpleasant taste. Effects were inconclusive because of imprecise estimates of effects: CHM versus placebo (RR 1.51; 95% CI 0.69 to 3.33; 7 trials, 705 women; I² = 40%); CHM versus HT (RR 0.96; 95% CI 0.66 to 1.39; 2 RCTs, 864 women; I² = 0%); and CHM versus specific conventional medications (such as Fluoxetine and Estazolam) (RR 0.20; 95% CI 0.03 to 1.17; 2 RCTs, 139 women; I² = 61%). Authors’ conclusions We found insufficient evidence that Chinese herbal medicines were any more or less effective than placebo or HT for the relief of vasomotor symptoms. Effects on safety were inconclusive. The quality of the evidence ranged from very low to moderate; there is a need for well-designed randomised controlled studies. PMID:26976671

Cardiorespiratory interactions during periodic breathing in awake chronic heart failure patients.

PubMed

Pinna, G D; Maestri, R; Mortara, A; La Rovere, M T

2000-03-01

We applied spectral techniques to the analysis of cardiorespiratory signals [instantaneous lung volume (ILV), instantaneous tidal volume (ITV), arterial O(2) saturation (Sa(O(2))) at the ear, heart rate (HR), systolic (SAP), and diastolic (DAP) arterial pressure] during nonapneic periodic breathing (PB) in 29 awake chronic heart failure (CHF) patients and estimated the timing relationships between respiratory and slow cardiovascular (<0.04 Hz) oscillations. Our aim was 1) to elucidate major mechanisms involved in cardiorespiratory interactions during PB and 2) to test the hypothesis of a central vasomotor origin of PB. All cardiovascular signals were characterized by a dominant (>/=84% of total power) oscillation at the frequency of PB (mean +/- SE: 0.022 +/- 0.0008 Hz), highly coherent (>/=0.89), and delayed with respect to ITV (ITV-HR, 2.4 +/- 0.72 s; ITV-SAP, 6.7 +/- 0.65 s; ITV-DAP, 3.2 +/- 0.61 s; P < 0.01). Sa(O(2)) was highly coherent with (coherence function = 0.96 +/- 0. 009) and almost opposite in phase to ITV. These findings demonstrate the existence of a generalized cardiorespiratory rhythm led by the ventilatory oscillation and suggest that 1) the cyclic increase in inspiratory drive and cardiopulmonary reflexes and 2) mechanical effects of PB-induced changes in intrathoracic pressure are the more likely sources of the HR and blood pressure oscillations, respectively. The timing relationship between ITV and blood pressure signals excludes the possibility that PB represents the effect of a central vasomotor rhythm.

Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease.

PubMed

Duffy, S J; Keaney , J F; Holbrook, M; Gokce, N; Swerdloff, P L; Frei, B; Vita, J A

2001-07-10

Epidemiological studies suggest that tea consumption decreases cardiovascular risk, but the mechanisms of benefit remain undefined. Endothelial dysfunction has been associated with coronary artery disease and increased oxidative stress. Some antioxidants have been shown to reverse endothelial dysfunction, and tea contains antioxidant flavonoids. Methods and Results-- To test the hypothesis that tea consumption will reverse endothelial dysfunction, we randomized 66 patients with proven coronary artery disease to consume black tea and water in a crossover design. Short-term effects were examined 2 hours after consumption of 450 mL tea or water. Long-term effects were examined after consumption of 900 mL tea or water daily for 4 weeks. Vasomotor function of the brachial artery was examined at baseline and after each intervention with vascular ultrasound. Fifty patients completed the protocol and had technically suitable ultrasound measurements. Both short- and long-term tea consumption improved endothelium- dependent flow-mediated dilation of the brachial artery, whereas consumption of water had no effect (P<0.001 by repeated-measures ANOVA). Tea consumption had no effect on endothelium-independent nitroglycerin-induced dilation. An equivalent oral dose of caffeine (200 mg) had no short-term effect on flow-mediated dilation. Plasma flavonoids increased after short- and long-term tea consumption. Short- and long-term black tea consumption reverses endothelial vasomotor dysfunction in patients with coronary artery disease. This finding may partly explain the association between tea intake and decreased cardiovascular disease events.

Health symptoms during midlife in relation to menopausal transition: British prospective cohort study

PubMed Central

Kuh, Diana

2012-01-01

Objective To characterise symptoms experienced by women during the transition into natural menopause, to classify women into distinct symptom profiles or trajectories, and to relate these profiles to sociodemographic factors and health behaviours. Design Nationally representative cohort study. Setting England, Scotland, and Wales. Participants 695 women followed-up since birth in 1946 and annually from age 47 to 54 who experienced natural menopause and reported on 20 common health symptoms. Main outcome measure Longitudinal profiles for reported bothersome symptoms. Results Of 20 individual symptoms, 18 formed into four stable symptom groups: psychological, somatic, vasomotor, and sexual discomfort. Using latent class analyses, all except the somatic group of symptoms showed a clear relation with the timing of menopause for some women. A small proportion of women (10%, n=63) had a severe psychological symptom profile that peaked at or in the year after menopause. For vasomotor symptoms, 14% of women (n=83) had the early severe profile that also peaked around early postmenopause and then declined noticeably; 11% (n=67) had the late severe profile of bothersome symptoms that increased rapidly in perimenopause and remained high for four years or more after menopause. Women were less likely to have a profile for severe vasomotor symptoms if they were from a non-manual social class (odds ratio 0.79, 95% confidence interval 0.57 to 1.01) or had degree level qualifications (0.37, 0.18 to 0.77). The 14% of women (n=85) who had the late severe profile for sexual discomfort showed a similar increase in symptoms until menopause, with symptoms persisting after menopause. Married women were more likely to have the late severe or late moderate profile than women of other marital status (2.40, 1.30 to 4.41). Four profiles each were identified for somatic symptoms (mild, moderate, severe, and very severe), although these did not vary by chronological age or age at menopause. Conclusion Profiles for psychological, vasomotor, and sexual discomfort symptoms relative to age at menopause could help health professionals to tailor their advice for women with natural menopause. PMID:22318435

Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial.

PubMed

Goranitis, Ilias; Bellanca, Leana; Daley, Amanda J; Thomas, Adele; Stokes-Lampard, Helen; Roalfe, Andrea K; Jowett, Sue

2017-01-01

To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms. Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective. Primary care. Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience ≥ 5 episodes of vasomotor symptoms daily. An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD), aimed to prompt exercise with purpose-designed DVD and written materials, whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group, who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates. Cost per quality-adjusted life-year (QALY). Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was £52 (CIs: £18 to £86) and £18 (CIs: -£68 to £105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs, resulting in an incremental cost-effectiveness ratio of £8,940 and £1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings. Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms.

Aerobic exercise for vasomotor menopausal symptoms: A cost-utility analysis based on the Active Women trial

PubMed Central

Goranitis, Ilias; Bellanca, Leana; Daley, Amanda J.; Thomas, Adele; Stokes-Lampard, Helen; Roalfe, Andrea K.

2017-01-01

Objective To compare the cost-utility of two exercise interventions relative to a control group for vasomotor menopausal symptoms. Design Economic evaluation taking a UK National Health Service and Personal Social Services perspective and a societal perspective. Setting Primary care. Population Peri- and postmenopausal women who have not used hormone therapy in the past 3 months and experience ≥ 5 episodes of vasomotor symptoms daily. Methods An individual and a social support-based exercise intervention were evaluated. The former (Exercise-DVD), aimed to prompt exercise with purpose-designed DVD and written materials, whereas the latter (Exercise-Social support) with community exercise social support groups. Costs and outcomes associated with these interventions were compared to those of a control group, who could only have an exercise consultation. An incremental cost-utility analysis was undertaken using bootstrapping to account for the uncertainty around cost-effectiveness point-estimates. Main outcome measure Cost per quality-adjusted life-year (QALY). Results Data for 261 women were available for analysis. Exercise-DVD was the most expensive and least effective intervention. Exercise-Social support was £52 (CIs: £18 to £86) and £18 (CIs: -£68 to £105) more expensive per woman than the control group at 6 and 12 months post-randomisation and led to 0.006 (CIs: -0.002 to 0.014) and 0.013 (CIs: -0.01 to 0.036) more QALYs, resulting in an incremental cost-effectiveness ratio of £8,940 and £1,413 per QALY gained respectively. Exercise-Social support had 80%-90% probability of being cost-effective in the UK context. A societal perspective of analysis and a complete-case analysis led to similar findings. Conclusions Exercise-Social support resulted in a small gain in health-related quality of life at a marginal additional cost in a context where broader wellbeing and long-term gains associated with exercise and social participation were not captured. Community exercise social support groups are very likely to be cost-effective in the management of vasomotor menopausal symptoms. PMID:28949974

The pharmacological and hormonal therapy of hot flushes in breast cancer survivors.

PubMed

Wiśniewska, Iwona; Jochymek, Bożena; Lenart-Lipińska, Monika; Chabowski, Mariusz

2016-03-01

The side effects of oncological treatment, which appear during or after therapy, are sometimes very annoying for patients and are not adequately treated by physicians. Among the symptoms experienced by breast cancer patients are hot flushes, which result from a natural or cancer therapy-induced menopause. The intensity of hot flushes in breast cancer patients may be more severe than those experienced by women undergoing a natural menopause. Taking into account the incidence of breast cancer and long-lasting hormone-suppression therapies, the problem of hot flushes will affect many women. Hormonal replacement therapy, the most effective therapeutic means for alleviating hot flushes, is usually contraindicated for breast cancer patients. For intense and severe hot flushes, pharmacological treatment using agents from a group of selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors such as venlafaxine or citalopram may be introduced. Other agents from different pharmacological groups, such as clonidine, gabapentin, or pregabalin, have also proved to be effective in treating hot flushes. The efficacy of phytoestrogens has not been proven in randomized clinical trials. The importance of the placebo effect in decreasing vasomotor symptoms has also been reported in many research papers. Educating breast cancer patients in lifestyle changes which decrease the frequency and intensity of vasomotor symptoms can offer significant help too. This paper reviews the current state of research in order to assess the options for the treatment of hot flushes in breast cancer survivors.

Thermographic analysis and autonomic response in the hands of patients with leprosy.

PubMed

Cavalheiro, Aretusa Lopes; Costa, Debora Tacon da; Menezes, Ana Luiza Ferro de; Pereira, Janser Moura; Carvalho, Eliane Maria de

2016-01-01

Low temperatures and slow blood flow may result from peripheral neuropathy caused by leprosy, and the simple detection of cold fingers could already be a preliminary classification for these patients. To investigate whether infrared thermography would be able to measure this change in temperature in the hands of people with leprosy. The study assessed 17 leprosy patients who were under treatment at the National Reference Center for Sanitary Dermatology and Leprosy, Uberlândia/MG, and 15 people without leprosy for the control group. The infrared camera FLIR A325 and Therma CAM Researcher Professional 2.9 software were used to measure the temperature. The room was air-conditioned, maintaining the temperature at 25°C; the distance between the camera and the limb was 70 cm. The vasomotor reflex of patients was tested by a cold stress on the palm. The study showed a significant interaction between the clinical form of leprosy and temperature, where the control group and the borderline-borderline form revealed a higher initial temperature, while borderline-lepromatous and lepromatous leprosy showed a lower temperature. Regarding vasomotor reflex, lepromatous leprosy patients were unable to recover the initial temperature after cold stress, while those with the borderline-tuberculoid form not only recovered but exceeded the initial temperature. Thermography proved a potential tool to assist in the early detection of neuropathies, helping in the prevention of major nerve damage and the installation of deformities and disabilities that are characteristic of leprosy.

Nonuniformity in the von Bezold-Jarisch reflex.

PubMed

Salo, Lauren M; Woods, Robyn L; Anderson, Colin R; McAllen, Robin M

2007-08-01

The von Bezold-Jarisch reflex (BJR) is a vagally mediated chemoreflex from the heart and lungs, causing hypopnea, bradycardia, and inhibition of sympathetic vasomotor tone. However, cardiac sympathetic nerve activity (CSNA) has not been systematically compared with vasomotor activity during the BJR. In 11 urethane-anesthetized (1-1.5 g/kg iv), artificially ventilated rats, we measured CSNA simultaneously with lumbar sympathetic activity (LSNA) while the BJR was evoked by right atrial bolus injections of phenylbiguanide (0.5, 1.0, 1.5, and 2 microg). Nerve and heartbeat responses were analyzed by calculating normalized cumulative sums. LSNA and heartbeats were always reduced by the BJR. An excitatory "rebound" component often followed the inhibition of LSNA but never outweighed it. For CSNA, however, excitation usually (in 7 of 11 rats) outweighed any initial inhibition, such that the net response to phenylbiguanide was excitatory. The differences in net response between LSNA, CSNA, and heartbeats were all significant (P < 0.01). A second experimental series on seven rats showed that methyl atropine (1 mg/kg iv) abolished the bradycardia of the BJR, whereas subsequent bilateral vagotomy substantially reduced LSNA and CSNA responses, both excitatory and inhibitory. These findings show that, during the BJR, 1) CSNA is often excited, 2) there may be coactivation of sympathetic and parasympathetic drives to the heart, 3) divergent responses may be evoked simultaneously in cardiac vagal, cardiac sympathetic, and vasomotor nervous pathways, and 4) those divergent responses are mediated primarily by the vagi.

The effects of progesterone selection on psychological symptoms in hormone replacement therapy.

PubMed

Caglayan, Emel Kiyak; Kara, Mustafa; Etiz, Sema; Kumru, Pinar; Aka, Nurettin; Kose, Gultekin

2014-01-01

The aim of this study is to evaluate the effects of hormone replacement therapy using dienogest and medroxyprogesterone acetate on psychological symptoms in perimenopausal and postmenopausal women. A total of 73 patients who sought treatment at the menopause units of the authors' gynecology and obstetrics clinics between of November 2003 and October 2004 complaining of vasomotor symptoms were included in the study prospectively. The cases were divided into two groups: Group I (37 patients) was given 2 mg estradiol valerate and 2 mg dienogest, and Group II (36 patients) was given 2 mg estradiol valerate and 10 mg medroxyprogesterone acetate. The groups' results in months 0 and 6 were compared through the evaluation of vasomotor and psychological symptom levels. No significant difference was found between the groups when the initial levels of vasomotor and psychological symptom subtypes were compared (p = 0.16). It was observed that all the psychological symptoms decreased in the 6th month in the group using dienogest in comparison with the initial situation, and that psychological symptoms increased in the group using medroxyprogesterone acetate in the evaluation performed in the 6th month compared with the initial levels. It was also found out that there was a statistically significant difference between the two groups when compared in terms of these symptoms (p < 0.0001). While the use of dienogest normalizes the general psychological situation and sleep, it was observed that the use of medroxyprogesterone acetate (MPA) worsens the general psychological situation.

Overview of methods used in cross-cultural comparisons of menopausal symptoms and their determinants: Guidelines for Strengthening the Reporting of Menopause and Aging (STROMA) studies.

PubMed

Melby, Melissa K; Sievert, Lynnette Leidy; Anderson, Debra; Obermeyer, Carla Makhlouf

2011-10-01

This paper reviews the methods used in cross-cultural studies of menopausal symptoms with the goal of formulating recommendations to facilitate comparisons of menopausal symptoms across cultures. It provides an overview of existing approaches and serves to introduce four separate reviews of vasomotor, psychological, somatic, and sexual symptoms at midlife. Building on an earlier review of cross-cultural studies of menopause covering time periods until 2004, these reviews are based on searches of Medline, PsycINFO, CINAHL and Google Scholar for English-language articles published from 2004 to 2010 using the terms "cross cultural comparison" and "menopause." Two major criteria were used: a study had to include more than one culture, country, or ethnic group and to have asked about actual menopausal symptom experience. We found considerable variation across studies in age ranges, symptom lists, reference period for symptom recall, variables included in multivariate analyses, and the measurement of factors (e.g., menopausal status and hormonal factors, demographic, anthropometric, mental/physical health, and lifestyle measures) that influence vasomotor, psychological, somatic and sexual symptoms. Based on these reviews, we make recommendations for future research regarding age range, symptom lists, reference/recall periods, and measurement of menopausal status. Recommendations specific to the cross-cultural study of vasomotor, psychological, somatic, and sexual symptoms are found in the four reviews that follow this introduction. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

The menopausal experience among indigenous women of Sarawak, Malaysia.

PubMed

Syed Alwi, S A R; Lee, P Y; Awi, I; Mallik, P S; Md Haizal, M N

2009-12-01

To document the common menopausal symptoms and quality of life in indigenous women of Sarawak in Malaysia. A face-to-face interview using the Menopause-specific Quality of Life questionnaire was conducted with 276 indigenous Sarawakian women aged 40-65 years to determine the mean age of menopause and common symptoms (divided into vasomotor, psychosocial, physical and sexual domains) associated with menopause. The mean age at menopause of postmenopausal women was 50.78 +/- 2.47 years (range 47.3-58.2 years). The most common symptoms reported were aching in muscles and joints (82.6%), lack of energy (77.5%) and low backache (77.2%). The typical menopausal symptoms of hot flushes, night sweats, sweating and vaginal dryness were experienced by 42.4%, 34.8%, 29.7% and 49.3%, respectively of the women studied. Perimenopausal women (n = 114) experienced the most physical and psychosocial symptoms, while postmenopausal women (n = 102) experienced most sexual symptoms. Perimenopausal and postmenopausal women were reported to suffer more than premenopausal women (p < 0.001) within the four domains of symptoms (vasomotor, psychosocial, physical and sexual). The menopausal symptoms in this study correspond to those in other studies on Asian women but the prevalence of typical and classical menopausal symptoms was lower compared to studies on Caucasian women. The perimenopausal women had the most significant decrease in quality of life, followed by postmenopausal women and premenopausal women. Vasomotor symptoms had a predominant influence on the quality of life.

Mitochondria and Endothelial Function

PubMed Central

Kluge, Matthew A.; Fetterman, Jessica L.; Vita, Joseph A.

2013-01-01

In contrast to their role in other cell types with higher energy demands, mitochondria in endothelial cells primarily function in signaling cellular responses to environmental cues. This article provides an overview of key aspects of mitochondrial biology in endothelial cells, including subcellular location, biogenesis, dynamics, autophagy, ROS production and signaling, calcium homeostasis, regulated cell death, and heme biosynthesis. In each section, we introduce key concepts and then review studies showing the importance of that mechanism to endothelial control of vasomotor tone, angiogenesis, and inflammatory activation. We particularly highlight the small number of clinical and translational studies that have investigated each mechanism in human subjects. Finally, we review interventions that target different aspects of mitochondrial function and their effects on endothelial function. The ultimate goal of such research is the identification of new approaches for therapy. The reviewed studies make it clear that mitochondria are important in endothelial physiology and pathophysiology. A great deal of work will be needed, however, before mitochondria-directed therapies are available for the prevention and treatment of cardiovascular disease. PMID:23580773

The influence of environmental factors on heart rate chronostructure depending on the individual characteristics of autonomic regulation. Results of long-term medical-ecological studies.

NASA Astrophysics Data System (ADS)

Isaeva, Olga; Zenchenko, Tatiana; Breus, Tamara; Chernikova, Anna; Baevsky, Roman

It was previously shown [Baevsky, Petrov, 1998] that during space flight under influence of geomagnetic disturbances there are both specific response of the autonomic regulation system in the form of vasomotor cardiovascular center activation (LF spectral components) and non-specific stress response, which depends on the actual autonomic balance [Breus, Baevsky, 2002]. Within the project "Mars-500" the parallel medical-ecological studies were conducted in 10 groups (10-16 people), that lived in different regions of the world under the influence of various environmental factors - climatic, geographic, industrial, social and other. It allowed us to obtain a sufficiently large number of variants of adaptive reactions caused by differences in external impacts. The main research method was the heart rate variability (HRV) analysis in short ECG samples (5 minutes) for assessing heart rate chronostructure and functional status of autonomic regulation. Results of studies have demonstrated that environmental loads on the regulatory mechanisms is higher in the northern and north-eastern regions of Russia - Magadan and Syktyvkar. Stress-index of regulatory systems and adaptive risk indicator is significantly higher in these groups [Baevsky, Berseneva, 2013]. The preliminary search of weather factors (atmospheric pressure, air temperature, humidity and magnetic index Kp) influence on the autonomic regulation of heart rate showed that there are no any significant changes and relationships in the entire group of participants. We have assumed that the character of adaptive responses, including responses to changing weather and geomagnetic conditions, is associated with the individual characteristics and the initial functional state of autonomic regulation. To test this hypothesis, we have identified two groups of subjects with different autonomic balance. The first group included individuals with a pronounced predominance of sympathetic regulation (n = 127), the second - with a strong predominance of parasympathetic activity (n = 64). The analysis of correlations between weather and heart rate chronostructure and functional condition of autonomic regulation revealed that attitude of low frequency (LF) and high frequency (HF) of heart rhythm spectrum higher in both groups at declining geomagnetic activity and lower at its growth. The comparison of other HRV indicators at decreasing and increasing geomagnetic activity displayed the opposite trends in these groups. Stress-index of regulatory systems (SI), which reflects the sympathetic activity, rises in group with sympathetic dominance at reducing geomagnetic activity, and at its growth - in group with parasympathetic dominance. So, we can see that specific adaptive reaction as response to changing geomagnetic situation, which manifested in activation of vasomotor cardiovascular center, is the similar in subjects with different autonomic balance. Non-specific component depends on initial dominance of one or another regulatory mechanism.

Quantitative pilomotor axon reflex test: a novel test of pilomotor function.

PubMed

Siepmann, Timo; Gibbons, Christopher H; Illigens, Ben M; Lafo, Jacob A; Brown, Christopher M; Freeman, Roy

2012-11-01

Cutaneous autonomic function can be quantified by the assessment of sudomotor and vasomotor responses. Although piloerector muscles are innervated by the sympathetic nervous system, there are at present no methods to quantify pilomotor function. To quantify piloerection using phenylephrine hydrochloride in humans. Pilot study. Hospital-based study. Twenty-two healthy volunteers (18 males,4 females) aged 24 to 48 years participated in 6 studies. Piloerection was stimulated by iontophoresis of 1% phenylephrine. Silicone impressions of piloerection were quantified by number and area. The direct and indirect responses to phenylephrine iontophoresis were compared on both forearms after pre treatment to topical and subcutaneous lidocaine and iontophoresis of normal saline. Iontophoresis of phenylephrine induced piloerection in both the direct and axon reflex–mediated regions, with similar responses in both arms. Topical lidocaine blocked axon reflex–mediated piloerection post-iontophoresis (mean [SD], 66.6 [19.2] for control impressions vs 7.2 [4.3] for lidocaine impressions;P.001). Subcutaneous lidocaine completely blocked piloerection.The area of axon reflex–mediated piloerection was also attenuated in the lidocaine-treated region postiontophoresis (mean [SD], 46.2 [16.1]cm2 vs 7.2 [3.9]cm2; P.001). Piloerection was delayed in the axon reflex region compared with the direct region. Normal saline did not cause piloerection. Phenylephrine provoked piloerection directly and indirectly through an axon reflex–mediated response that is attenuated by lidocaine. Piloerection is not stimulated by iontophoresis of normal saline alone.The quantitative pilomotor axon reflex test (QPART) may complement other measures of cutaneous autonomic nerve fiber function.

Nonallergic rhinopathy

MedlinePlus

... as vasomotor rhinitis. Causes Nonallergic rhinopathy is not caused by an infection or allergy. The exact cause is unknown. Symptoms are triggered by something that irritates the nose, such as: A dry atmosphere Air pollution Alcohol Certain medicines Spicy foods, and in some ...

Menopause and Stroke: An Epidemiologic Review

PubMed Central

Lisabeth, Lynda; Bushnell, Cheryl

2012-01-01

Although women have a lower risk of stroke during middle age, the menopausal transition is a time when many women develop cardiovascular risk factors. In addition, during the 10 years after menopause, the risk of stroke roughly doubles in women. Endogenous estrogen levels decline by 60% during the menopausal transition, leading to a relative androgen excess, which could contribute to the increased cardiovascular risk factors in women. Earlier onset of menopause may influence the risk of stroke, but the data are not clear. Because of the stroke risk associated with hormone therapy, this is only indicated for treatment of vasomotor symptoms, but some formulations may be safe than others. More research is needed to understand which women are at greatest stroke risk during midlife and to determine the safest formulation, dose, and duration of hormone therapy that will treat vasomotor symptoms without increasing the risk for stroke. PMID:22172623

Cerebral vasomotor reactivity in neurodegenerative diseases.

PubMed

Smoliński, Łukasz; Członkowska, Anna

Small-caliber cerebral vessels change their diameters in response to alterations of key metabolite concentrations such as carbon dioxide or oxygen. This phenomenon, termed the cerebral vasomotor reactivity (CVMR), is the basis for blood flow regulation in the brain in accordance with its metabolic status. Typically, CVMR is determined as the amount of change in cerebral blood flow in response to a vasodilating stimulus, which can be measured by various neuroimaging methods or by transcranial Doppler. It has been shown that CVMR is impaired in cerebrovascular diseases, but there is also evidence of a similar dysfunction in neurodegenerative disorders. Here, we review studies that have investigated CVMR in the common neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease and multiple sclerosis. Moreover, we discuss potential neurodegenerative mechanisms responsible for the impairment of CVMR. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Regional cerebral blood flow in childhood headache

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roach, E.S.; Stump, D.A.

1989-06-01

Regional cerebral blood flow (rCBF) was measured in 16 cranial regions in 23 children and adolescents with frequent headaches using the non-invasive Xenon-133 inhalation technique. Blood flow response to 5% carbon dioxide (CO2) was also determined in 21 patients, while response to 50% oxygen was measured in the two patients with hemoglobinopathy. Included were 10 patients with a clinical diagnosis of migraine, 4 with musculoskeletal headaches, and 3 with features of both types. Also studied were 2 patients with primary thrombocythemia, 2 patients with hemoglobinopathy and headaches, 1 patient with polycythemia, and 1 with headaches following trauma. With two exceptions,more » rCBF determinations were done during an asymptomatic period. Baseline rCBF values tended to be higher in these young patients than in young adults done in our laboratory. Localized reduction in the expected blood flow surge after CO2 inhalation, most often noted posteriorly, was seen in 8 of the 13 vascular headaches, but in none of the musculoskeletal headache group. Both patients with primary thrombocythemia had normal baseline flow values and altered responsiveness to CO2 similar to that seen in migraineurs; thus, the frequently reported headache and transient neurologic signs with primary thrombocythemia are probably not due to microvascular obstruction as previously suggested. These data support the concept of pediatric migraine as a disorder of vasomotor function and also add to our knowledge of normal rCBF values in younger patients. Demonstration of altered vasomotor reactivity to CO2 could prove helpful in children whose headache is atypical.« less

Retinovascular physiology and pathophysiology: new experimental approach/new insights

PubMed Central

Puro, Donald G.

2012-01-01

An important challenge in visual neuroscience is understand the physiology and pathophysiology of the intra-retinal vasculature, whose function is required for ophthalmoception by humans and most other mammals. In the quest to learn more about this highly specialized portion of the circulatory system, a newly developed method for isolating vast microvascular complexes from the rodent retina has opened the way for using techniques such as patch-clamping, fluorescence imaging and time-lapse photography to elucidate the functional organization of a capillary network and its pre-capillary arteriole. For example, the ability to obtain dual perforated-patch recordings from well-defined sites within an isolated microvascular complex permitted the first characterization of the electrotonic architecture of a capillary/arteriole unit. This analysis revealed that this operational unit is not simply a homogenous synctium, but has a complex functional organization that is dynamically modulated by extracellular signals such as angiotensin II. Another recent discovery is that a capillary and its pre-capillary arteriole have distinct physiological differences; capillaries have an abundance of ATP-sensitive potassium (KATP) channels and a dearth of voltage-dependent calcium channels (VDCCs) while the converse is true for arterioles. In addition, voltage transmission between abluminal cells and the endothelium is more efficient in the capillaries. Thus, the capillary network is well-equipped to generate and transmit voltages, and the pre-capillary arteriole is well-adapted to transduce a capillary-generated voltage into a change in abluminal cell calcium and thereby, a vasomotor response. Use of microvessels isolated from the diabetic retina has led to new insights concerning retinal vascular pathophysiology. For example, soon after the onset of diabetes, the efficacy of voltage transmission through the endothelium is diminished; arteriolar VDCCs is inhibited, and there is increased vulnerability to purinergic vasotoxicity, which is a newly identified pathobiological mechanism. Other recent studies reveal that KATP channels not only have an essential physiological role in generating vasomotor responses, but their activation substantially boosts the lethality of hypoxia. Thus, the pathophysiology of the retinal microvasculature is closely linked with its physiology. PMID:22333041

Managing Depression during the Menopausal Transition

ERIC Educational Resources Information Center

Pearson, Quinn M.

2010-01-01

The menopausal transition is associated with both first onset of depression and recurrent depression. Risk factors include vasomotor symptoms, a history of premenstrual dysphoria, postpartum depression, major depression, and sleep disturbances. Hormone replacement therapy, complementary and alternative medicine approaches, and counseling…

Pathophysiology of hypertension: interactions between macro and microvascular alterations through endothelial dysfunction.

PubMed

Yannoutsos, Alexandra; Levy, Bernard I; Safar, Michel E; Slama, Gerard; Blacher, Jacques

2014-02-01

Hypertension is a multifactorial systemic chronic disorder through functional and structural macrovascular and microvascular alterations. Macrovascular alterations are featured by arterial stiffening, disturbed wave reflection and altered central to peripheral pulse pressure amplification. Microvascular alterations, including altered wall-to-lumen ratio of larger arterioles, vasomotor tone abnormalities and network rarefaction, lead to disturbed tissue perfusion and susceptibility to ischemia. Central arterial stiffness and microvascular alterations are common denominators of organ damages. Vascular alterations are intercorrelated, amplifying the haemodynamic load and causing further damage in the arterial network. A plausible precursor role of vascular alterations in incident hypertension provides new insights for preventive and therapeutic strategies targeting macro and microvasculature. Cumulative metabolic burden and oxidative stress lead to chronic endothelial injury, promoting structural and functional vascular alterations, especially in the microvascular network. Pathophysiology of hypertension may then be revisited, based on both macrovascular and microvascular alterations, with a precursor role of endothelial dysfunction for the latter.

Psychometric attributes of the Cervantes short-form questionnaire for measuring health-related quality of life in menopausal women.

PubMed

Coronado, Pluvio J; Sánchez-Borrego, Rafael; Ruiz, Miguel A; Baquedano, Laura; Sánchez, Sonia; Argudo, Cristina; Fernández-Abellán, Mariela; González, Silvia; Iglesias, Eva; Calleja, Jackie; Presa, Jesus; Duque, Alfonso; Ruiz, Fernando; Otero, Borja; Rejas, Javier

2016-02-01

To analyse the psychometric properties of the Cervantes scale short-form (SF) in the peri- and post-menopausal periods. Outpatients women 45-65 years with menstrual problems associated with the climacteric syndrome were analysed. Original and SF versions of the Cervantes scale were administered along with the EuroQol-5D (EQ-5D) and work productivity and activity impairment questionnaire (WPAI) scales. Conceptual model, burden of administration, feasibility, reliability, criteria validity and construct validity were assessed. 317 women [55.7±5.3 years (mean±standard deviation)] were recruited: 75.4% were post- and 22.3% were peri-menopausal. The Cervantes-SF was completed in 2.5±1.6min, and 86% answered all items. Cronbach's α was 0.820, and ranged from 0.510 (Aging) to 0.918 (Vasomotor Symptoms) for individual dimensions. The scale structure matched the structure of the original version, χ(2)/(degrees of freedom)=3.6, Comparative Fit Index=0.848, Tucker-Lewis Index=0.850, and root mean square error of approximation=0.099, although differences were found between sexual activity statuses. Criteria validity was good (r=0.890), concurrent validity was congruent with a priori hypothesis using either the EQ-5D or the WPAI scales. The scale discriminated significantly the severity of both vasomotor and genital climacteric associated symptoms. The Cervantes-SF has shown good psychometric properties for measuring Health related quality of life in peri- and post-menopausal women who regularly attended gynaecology clinics in Spain. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Mind-body Therapies for Menopausal Symptoms: A Systematic Review

PubMed Central

Innes, Kim E; Selfe, Terry Kit; Vishnu, Abhishek

2010-01-01

Objective To systematically review the peer-reviewed literature regarding the effects of self-administered mind-body therapies on menopausal symptoms. Methods To identify qualifying studies, we searched 10 scientific databases and scanned bibliographies of relevant review papers and all identified articles. The methodological quality of all studies was assessed systematically using predefined criteria. Results Twenty-one papers representing 18 clinical trials from 6 countries met our inclusion criteria, including 12 randomized controlled trials (N=719), 1 non-randomized controlled trial (N=58), and 5 uncontrolled trials (N=105). Interventions included yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low frequency sound-wave therapy. Eight of the nine studies of yoga, tai chi, and meditation-based programs reported improvement in overall menopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating vasomotor and other menopausal symptoms, although intergroup findings were mixed. Most studies reviewed suffered methodological or other limitations, complicating interpretation of findings. Conclusions Collectively, findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Additional large, methodologically sound trials are needed to determine the effects of specific mind-body therapies on menopausal symptoms, examine long-term outcomes, and investigate underlying mechanisms. PMID:20167444

Hormonal changes during menopause.

PubMed

Al-Azzawi, Farook; Palacios, Santiago

2009-06-20

Ovarian senescence occurs gradually during the fourth and fifth decades of life, leading to menopause at an average age of about 51 years. This senescence results in a changing hormonal milieu, with decreases in the levels of estrogens and androgens. Similar changes may be induced by surgical menopause (bilateral oophorectomy) or ovarian failure resulting from cancer treatment. The declining levels of estrogens and androgens affect many tissues of the body and can produce a variety of signs and symptoms, including vasomotor symptoms, decreased bone density, changes in mood and energy, loss of pubic hair and changes in the genital tissues, and effects on sexual function. Accurate measurement of testosterone levels in postmenopausal women requires methods that are validated in the lower ranges of testosterone level observed in this population.

Neural mechanisms in nitric-oxide-deficient hypertension

NASA Technical Reports Server (NTRS)

Sander, M.; Victor, R. G.; Blomqvist, C. G. (Principal Investigator)

1999-01-01

Nitric oxide is hypothesized to be an inhibitory modulator of central sympathetic nervous outflow, and deficient neuronal nitric oxide production to cause sympathetic overactivity, which then contributes to nitric-oxide-deficient hypertension. The biochemical and neuroanatomical basis for this concept revolves around nitric oxide modulation of glutamatergic neurotransmission within brainstem vasomotor centers. The functional consequence of neuronal nitric oxide in blood pressure regulation is, however, marked by an apparent conflict in the literature. On one hand, conscious animal studies using sympathetic blockade suggest a significant role for neuronal nitric oxide deficiency in the development of nitric-oxide-deficient hypertension, and on the other hand, there is evidence against such a role derived from 'knock-out' mice lacking nitric-oxide synthase 1, the major source of neuronal nitric oxide.

Menopausal symptoms in young survivors of breast cancer: a growing problem without an ideal solution.

PubMed

Murthy, Vijayashree; Chamberlain, Ronald S

2012-10-01

New breast cancers occur in 25% to 30% of women < 50 years of age. These young women undergo ablative surgery, chemotherapy, or hormonal/targeted treatment. These treatments have resulted in increased survival but at the expense of early menopause, marked by distressing vasomotor symptoms, sexual dysfunction, decreased metabolism, and musculoskeletal and cardiovascular effects. A comprehensive literature search was performed using PubMed. This article reviews the evidence-based approaches to the treatment of these distressing symptoms in young breast cancer survivors. Menopausal symptoms in young patients are typically more severe due to the abrupt and rapid decrease in estrogen, and chemotherapy and hormones worsen these symptoms. Evidence supporting the efficacy of most complementary therapies is scarce. Behavioral modification and yoga may be helpful in mild cases of vasomotor symptoms, whereas newer antidepressants are promising in moderate to severe cases, and stellate ganglion block may be used in refractory cases. Local vaginal moisturizers, and in refractory cases low-dose estrogen creams, may ameliorate most urogenital symptoms. Bisphosphonates, vitamin D, and calcium can treat osteoporosis, and weight-bearing exercises decrease bone mineral density loss and help to control weight. Smoking cessation, exercise, and dietary modifications should be recommended to all young patients to decrease cardiac morbidity. At present, there is insufficient evidence to support any natural agent as a viable alternative to hormone replacement therapy to treat these symptoms. No single agent can ameliorate vasomotor, cardiac, skeletal, and sexual concerns of young breast cancer survivors coping with menopausal symptoms. Quality-of-life research involving premenopausal breast cancer survivors is lacking. Further study is needed to identify safe and effective treatments for menopausal symptoms and to confirm their long-term safety in young breast cancer survivors.

Topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on nonhormonal management of vasomotor symptoms.

PubMed

Carpenter, Janet S; Laine, Tei; Harrison, Blake; LePage, Meghan; Pierce, Taran; Hoteling, Nathan; Börner, Katy

2017-10-01

We sought to depict the topical, geospatial, and temporal diffusion of the 2015 North American Menopause Society position statement on the nonhormonal management of menopause-associated vasomotor symptoms released on September 21, 2015, and its associated press release from September 23, 2015. Three data sources were used: online news articles, National Public Radio, and Twitter. For topical diffusion, we compared keywords and their frequencies among the position statement, press release, and online news articles. We also created a network figure depicting relationships across key content categories or nodes. For geospatial diffusion within the United States, we compared locations of the 109 National Public Radio (NPR) stations covering the statement to 775 NPR stations not covering the statement. For temporal diffusion, we normalized and segmented Twitter data into periods before and after the press release (September 12, 2015 to September 22, 2015 vs September 23, 2015 to October 3, 2015) and conducted a burst analysis to identify changes in tweets from before to after. Topical information diffused across sources was similar with the exception of the more scientific terms "vasomotor symptoms" or "vms" versus the more colloquial term "hot flashes." Online news articles indicated media coverage of the statement was mainly concentrated in the United States. NPR station data showed similar proportions of stations airing the story across the four census regions (Northeast, Midwest, south, west; P = 0.649). Release of the statement coincided with bursts in the menopause conversation on Twitter. The findings of this study may be useful for directing the development and dissemination of future North American Menopause Society position statements and/or press releases.

MF-101, an estrogen receptor beta agonist for the treatment of vasomotor symptoms in peri- and postmenopausal women.

PubMed

Stovall, Dale W; Pinkerton, Joann V

2009-04-01

During peri- and postmenopausal stages, the majority of women experience moderate-to-severe vasomotor symptoms, such as hot flashes and night sweats, that interfere with sleep and reduce quality of life. Estrogen alone or in combination with a progestagen has been the standard therapy for such vasomotor symptoms; however, this therapeutic regimen is associated with severe side effects, such as breast cancer or cardiovascular events. To provide a better treatment option for menopausal women, Bionovo Inc is developing the estrogen receptor (ER)beta-selective agonist MF-101. Selective ER agonists can stimulate either ERalpha or ERbeta and induce tissue-specific estrogen-like effects, thus providing a safer alternative to conventional hormone therapy. MF-101 is derived from 22 herbs that are traditionally used in Chinese medicine for the treatment of menopausal symptoms. MF-101 did not promote the growth of breast cancer cells or stimulate uterine growth in preclinical studies and, in a phase II trial, was demonstrated to be safe and more effective in reducing the frequency and severity of hot flashes in postmenopausal women compared with placebo. To confirm the safety and efficacy of MF-101, larger phase III trials were planned for 2009. Although MF-101 appears to be a promising therapeutic, the herbal composition of the drug may be a disadvantage, because of the increased risk of causing allergic reactions in the general population. Studies with the MF-101-isolated active compounds liquiritigen and chalcone demonstrated selectivity for ERbeta, with no induction of proliferative events. If these isolates were demonstrated to be as effective and safe in clinical trials as preliminary data suggest regarding MF-101, these compounds could change the way clinicians treat menopause-associated symptoms.

Vasomotor symptoms among Japanese-American and European-American women living in Hilo, Hawaii.

PubMed

Sievert, Lynnette Leidy; Morrison, Lynn; Brown, Daniel E; Reza, Angela M

2007-01-01

The Hilo Women's Health Survey was designed and administered to gather baseline data on women's health in Hilo, HI. This randomized, cross-sectional study allowed for a focus on ethnic differences in symptom reporting. The results presented here focus on hot flash and night sweat experience among Japanese-American and European-American women. Survey packets were mailed to street addresses associated with parcel numbers pulled randomly from Hilo tax maps. Of the 6,401 survey packets delivered to households, 1,824 questionnaires were completed and returned. The results reported here are based on 869 women aged 40 to 60, of whom 249 described themselves to be 100% Japanese and 203 described themselves to be 100% European-American. Logistic regression analyses were used to examine whether the relationship between ethnicity and vasomotor symptoms persisted after controlling for other variables. European-American participants were more likely to have ever experienced a hot flash as compared with Japanese-American participants (72% vs 53%, P<0.01). During the 2 weeks before the survey, European-American participants were more likely to have experienced hot flashes (P<0.05) and night sweats (P<0.01). In logistic regression analyses, after controlling for age, body mass index, menopause status, level of education, financial comfort, smoking habits, alcohol intake, exercise, use of hormone therapy, and soy intake, European-American women were still significantly more likely to have experienced hot flashes (odds ratio=1.858) and night sweats (odds ratio=2.672). The results, based on self-reporting of menopausal symptoms, indicate that Japanese-American women report fewer hot flashes and night sweats than European-American women. Japanese-American women reported a higher intake of soy, but soy intake was not associated with fewer vasomotor symptoms.

Menopause characteristics and subjective symptoms in women with and without spinal cord injury.

PubMed

Kalpakjian, Claire Z; Quint, Elisabeth H; Bushnik, Tamara; Rodriguez, Gianna M; Terrill, Melissa Sendroy

2010-04-01

To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI). Prospective cohort (4 data collection periods across 4 years). Community. Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed. None. Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms). The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness. Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of sapropterin on endothelium-dependent vasodilation in patients with CADASIL: a randomized controlled trial.

PubMed

De Maria, Renata; Campolo, Jonica; Frontali, Marina; Taroni, Franco; Federico, Antonio; Inzitari, Domenico; Tavani, Alessandra; Romano, Silvia; Puca, Emanuele; Orzi, Francesco; Francia, Ada; Mariotti, Caterina; Tomasello, Chiara; Dotti, Maria Teresa; Stromillo, Maria Laura; Pantoni, Leonardo; Pescini, Francesca; Valenti, Raffaella; Pelucchi, Claudio; Parolini, Marina; Parodi, Oberdan

2014-10-01

Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a rare autosomal dominant disorder caused by NOTCH3 mutations, is characterized by vascular smooth muscle and endothelial cells abnormalities, altered vasoreactivity, and recurrent lacunar infarcts. Vasomotor function may represent a key factor for disease progression. Tetrahydrobiopterin, essential cofactor for nitric oxide synthesis in endothelial cells, ameliorates endothelial function. We assessed whether supplementation with sapropterin, a synthetic tetrahydrobiopterin analog, improves endothelium-dependent vasodilation in CADASIL patients. In a 24-month, multicenter randomized, double-blind, placebo-controlled trial, CADASIL patients aged 30 to 65 years were randomly assigned to receive placebo or sapropterin 200 to 400 mg BID. The primary end point was change in the reactive hyperemia index by peripheral arterial tonometry at 24 months. We also assessed the safety and tolerability of sapropterin. Analysis was done by intention-to-treat. The intention-to-treat population included 61 patients. We found no significant difference between sapropterin (n=32) and placebo (n=29) in the primary end point (mean difference in reactive hyperemia index by peripheral arterial tonometry changes 0.19 [95% confidence interval, -0.18, 0.56]). Reactive hyperemia index by peripheral arterial tonometry increased after 24 months in 37% of patients on sapropterin and in 28% on placebo; however, after adjustment for age, sex, and clinical characteristics, improvement was not associated with treatment arm. The proportion of patients with adverse events was similar on sapropterin and on placebo (50% versus 48.3%); serious adverse events occurred in 6.3% versus 13.8%, respectively. Sapropterin was safe and well-tolerated at the average dose of 5 mg/kg/day, but did not affect endothelium-dependent vasodilation in CADASIL patients. https://www.clinicaltrialsregister.eu. Unique identifier: 2007-004370-55. © 2014 American Heart Association, Inc.

Isoflavones, calcium, vitamin D and inulin improve quality of life, sexual function, body composition and metabolic parameters in menopausal women: result from a prospective, randomized, placebo-controlled, parallel-group study.

PubMed

Vitale, Salvatore Giovanni; Caruso, Salvatore; Rapisarda, Agnese Maria Chiara; Cianci, Stefano; Cianci, Antonio

2018-03-01

Menopause results in metabolic changes that contribute to increase risk of cardiovascular diseases: increase in low density lipoprotein (LDL) and triglycerides and decrease in high density lipoprotein (HDL), weight gain are associated with a correspondent increase in incidence of hypertension and diabetes. The aim of this study was to evaluate the effect of a preparation of isoflavones, calcium vitamin D and inulin in menopausal women. We performed a prospective, randomized, placebo-controlled, parallel-group study. A total of 50 patients were randomized to receive either oral preparations of isoflavones (40 mg), calcium (500 mg) vitamin D (300 UI) and inulin (3 g) or placebo (control group). Pre- and post-treatment assessment of quality of life and sexual function were performed through Menopause-Specific Quality of Life Questionnaire (MENQOL) and Female Sexual Function Index (FSFI); evaluations of anthropometric indicators, body composition through bioelectrical impedance analyser, lumbar spine and proximal femur T-score and lipid profile were performed. After 12 months, a significant reduction in MENQOL vasomotor, physical and sexual domain scores ( p < 0.05) and a significant increase in all FSFI domain scores ( p < 0.05) were observed in treatment group. Laboratory tests showed significant increase in serum levels of HDL ( p < 0.05). No significant changes of lumbar spine and femur neck T-score ( p > 0.05) were found in the same group. According to our data analysis, isoflavones, calcium, vitamin D and inulin may exert favourable effects on menopausal symptoms and signs.

Role of central command in carotid baroreflex resetting in humans during static exercise

NASA Technical Reports Server (NTRS)

Ogoh, S.; Wasmund, W. L.; Keller, D. M.; O-Yurvati, A.; Gallagher, K. M.; Mitchell, J. H.; Raven, P. B.

2002-01-01

The purpose of the experiments was to examine the role of central command in the exercise-induced resetting of the carotid baroreflex. Eight subjects performed 30 % maximal voluntary contraction (MVC) static knee extension and flexion with manipulation of central command (CC) by patellar tendon vibration (PTV). The same subjects also performed static knee extension and flexion exercise without PTV at a force development that elicited the same ratings of perceived exertion (RPE) as those observed during exercise with PTV in order to assess involvement of the exercise pressor reflex. Carotid baroreflex (CBR) function curves were modelled from the heart rate (HR) and mean arterial pressure (MAP) responses to rapid changes in neck pressure and suction during steady state static exercise. Knee extension exercise with PTV (decreased CC activation) reset the CBR-HR and CBR-MAP to a lower operating pressure (P < 0.05) and knee flexion exercise with PTV (increased CC activation) reset the CBR-HR and CBR-MAP to a higher operating pressure (P < 0.05). Comparison between knee extension and flexion exercise at the same RPE with and without PTV found no difference in the resetting of the CBR-HR function curves (P > 0.05) suggesting the response was determined primarily by CC activation. However, the CBR-MAP function curves were reset to operating pressures determined by both exercise pressor reflex (EPR) and central command activation. Thus the physiological response to exercise requires CC activation to reset the carotid-cardiac reflex but requires either CC or EPR to reset the carotid-vasomotor reflex.

Sensitization of the Nociceptive System in Complex Regional Pain Syndrome

PubMed Central

Diedrichs, Carolina; Baron, Ralf; Gierthmühlen, Janne

2016-01-01

Background Complex regional pain syndrome type I (CRPS-I) is characterized by sensory, motor and autonomic abnormalities without electrophysiological evidence of a nerve lesion. Objective Aims were to investigate how sensory, autonomic and motor function change in the course of the disease. Methods 19 CRPS-I patients (17 with acute, 2 with chronic CRPS, mean duration of disease 5.7±8.3, range 1–33 months) were examined with questionnaires (LANSS, NPS, MPI, Quick DASH, multiple choice list of descriptors for sensory, motor, autonomic symptoms), motor and autonomic tests as well as quantitative sensory testing according to the German Research Network on Neuropathic Pain at two visits (baseline and 36±10.6, range 16–53 months later). Results CRPS-I patients had an improvement of sudomotor and vasomotor function, but still a great impairment of sensory and motor function upon follow-up. Although pain and mechanical detection improved upon follow-up, thermal and mechanical pain sensitivity increased, including the contralateral side. Increase in mechanical pain sensitivity and loss of mechanical detection were associated with presence of ongoing pain. Conclusions The results demonstrate that patients with CRPS-I show a sensitization of the nociceptive system in the course of the disease, for which ongoing pain seems to be the most important trigger. They further suggest that measured loss of function in CRPS-I is due to pain-induced hypoesthesia rather than a minimal nerve lesion. In conclusion, this article gives evidence for a pronociceptive pain modulation profile developing in the course of CRPS and thus helps to assess underlying mechanisms of CRPS that contribute to the maintenance of patients’ pain and disability. PMID:27149519

Bacteriological Controls at Czechoslovakia Blood Transfusion Centers.

DTIC Science & Technology

1961-07-01

and are followed by a steep rise in temperature. 3. The third phase is characterized by extreme distension of the arteries well visible in the mucous...by increased muscular rigidity. 4. The fourth phase is of shock, disappearance of vasomotor regulation, strong orthostatic hypotension with peripheral

[Effect of soybeans and soy sauce on vasomotor symptoms during menopause].

PubMed

Gutiérrez Martínez, María Del Mar; Riquelme Raya, Rebeca; Campos Martínez, Ana María; Lorite Garzón, Catalina; Strivens Vilchez, Helen; Ruiz Rodríguez, Concepción

2006-06-01

During menopause, some women experience symptoms which can interfere with their living quality. Some of these symptoms are the so-called vasomotor symptoms which include suffocations, hot flashes, and nocturnal sweats. Up to now, the most effective remedy was hormone treatment, but a study of isoflavines, such as soybean, suggests it is possible to alleviate the disturbances caused by menopause. Due to this study we consider that the addition of isoflavines can provide benefits to women. Therefore, it is correct to include them in the field of medicines which give an alternative to estrogen therapy. However, one must bear in mind that data about the efficiency and security of alternative medicines in the treatment of menopause symptoms are not conclusive since each woman is unique and it is necessary to have consensus on an individualized health plan which permits one to carry out adequate therapeutic adjustments in accordance to the needs which occur over the entire menopause process.

Extremely Low Birth Weight Preterm Infants Lack Vasomotor Response in Relationship to Cold Body Temperatures at Birth

PubMed Central

Knobel, Robin B.; Holditch-Davis, Diane; Schwartz, Todd A.; Wimmer, John E.

2009-01-01

Objective This study evaluated peripheral vasoconstriction in ELBW infants when body temperature decreased during the first 12-hours of life. Design An exploratory, within-subjects design with 10 ELBW infants. Abdominal and foot temperatures were measured every minute. Peripheral vasoconstriction (abdominal > peripheral temperature by 2° C) and abdominal-peripheral temperature difference were also evaluated. Results Abdominal and peripheral temperatures were significantly correlated within each infant. One 880 g infant exhibited isolated peripheral vasoconstriction; a 960 g infant had abdominal temperatures more than 1° C higher than peripheral temperatures. Eight smaller infants exhibited no peripheral vasoconstriction and spent most of their observations with peripheral greater than abdominal temperatures. In 8 infants, mean temperature difference was significantly higher when abdominal temperature was less than 36.5° C. Conclusion Most ELBW infants did not exhibit peripheral vasoconstriction during their first 12-hours of life, despite low temperatures. ELBW infants’ vasomotor control may be immature during this period. PMID:19626030

Alterations in perivascular innervation function in mesenteric arteries from offspring of diabetic rats

PubMed Central

de Queiroz, D B; Sastre, E; Caracuel, L; Callejo, M; Xavier, F E; Blanco-Rivero, J; Balfagón, G

2015-01-01

Background and Purpose We have reported that exposure to a diabetic intrauterine environment during pregnancy increases blood pressure in adult offspring, but the mechanisms involved are not completely understood. This study was designed to analyse a possible role of perivascular sympathetic and nitrergic innervation in the superior mesenteric artery (SMA) in this effect. Experimental Approach Diabetes was induced in pregnant Wistar rats by a single injection of streptozotocin. Endothelium-denuded vascular rings from the offspring of control (O-CR) and diabetic rats (O-DR) were used. Vasomotor responses to electrical field stimulation (EFS), NA and the NO donor DEA-NO were studied. The expressions of neuronal NOS (nNOS) and phospho-nNOS (P-nNOS) and release of NA, ATP and NO were determined. Sympathetic and nitrergic nerve densities were analysed by immunofluorescence. Key Results Blood pressure was higher in O-DR animals. EFS-induced vasoconstriction was greater in O-DR animals. This response was decreased by phentolamine more in O-DR animals than their controls. L-NAME increased EFS-induced vasoconstriction more strongly in O-DR than in O-CR segments. Vasomotor responses to NA or DEA-NO were not modified. NA, ATP and NO release was increased in segments from O-DR. nNOS expression was not modified, whereas P-nNOS expression was increased in O-DR. Sympathetic and nitrergic nerve densities were similar in both experimental groups. Conclusions and Implications The activity of sympathetic and nitrergic innervation is increased in SMA from O-DR animals. The net effect is an increase in EFS-induced contractions in these animals. These effects may contribute to the increased blood pressure observed in the offspring of diabetic rats. PMID:26177571

Breast feeding increases vasoconstriction induced by electrical field stimulation in rat mesenteric artery. Role of neuronal nitric oxide and ATP.

PubMed

Blanco-Rivero, Javier; Sastre, Esther; Caracuel, Laura; Granado, Miriam; Balfagón, Gloria

2013-01-01

The aim of this study was to investigate in rat mesenteric artery whether breast feeding (BF) affects the vasomotor response induced by electrical field stimulation (EFS), participation by different innervations in the EFS-induced response and the mechanism/s underlying these possible modifications. Experiments were performed in female Sprague-Dawley rats (3 months old), divided into three groups: Control (in oestrous phase), mothers after 21 days of BF, and mothers that had recovered their oestral cycle (After BF, in oestrous phase). Vasomotor response to EFS, noradrenaline (NA) and nitric oxide (NO) donor DEA-NO were studied. Neuronal NO synthase (nNOS) and phosphorylated nNOS (P-nNOS) protein expression were analysed and NO, superoxide anion (O(2)(.-)), NA and ATP releases were also determined. EFS-induced contraction was higher in the BF group, and was recovered after BF. 1 µmol/L phentolamine decreased the response to EFS similarly in control and BF rats. NA vasoconstriction and release were similar in both experimental groups. ATP release was higher in segments from BF rats. 0.1 mmol/L L-NAME increased the response to EFS in both control and BF rats, but more so in control animals. BF decreased NO release and did not modify O(2)(.-) production. Vasodilator response to DEA-NO was similar in both groups, while nNOS and P-nNOS expressions were decreased in segments from BF animals. Breast feeding increases EFS-induced contraction in mesenteric arteries, mainly through the decrease of neuronal NO release mediated by decreased nNOS and P-nNOS expression. Sympathetic function is increased through the increased ATP release in BF rats.

Breast Feeding Increases Vasoconstriction Induced by Electrical Field Stimulation in Rat Mesenteric Artery. Role of Neuronal Nitric Oxide and ATP

PubMed Central

Caracuel, Laura; Granado, Miriam; Balfagón, Gloria

2013-01-01

Objectives The aim of this study was to investigate in rat mesenteric artery whether breast feeding (BF) affects the vasomotor response induced by electrical field stimulation (EFS), participation by different innervations in the EFS-induced response and the mechanism/s underlying these possible modifications. Methods Experiments were performed in female Sprague-Dawley rats (3 months old), divided into three groups: Control (in oestrous phase), mothers after 21 days of BF, and mothers that had recovered their oestral cycle (After BF, in oestrous phase). Vasomotor response to EFS, noradrenaline (NA) and nitric oxide (NO) donor DEA-NO were studied. Neuronal NO synthase (nNOS) and phosphorylated nNOS (P-nNOS) protein expression were analysed and NO, superoxide anion (O2 .–), NA and ATP releases were also determined. Results EFS-induced contraction was higher in the BF group, and was recovered after BF. 1 µmol/L phentolamine decreased the response to EFS similarly in control and BF rats. NA vasoconstriction and release were similar in both experimental groups. ATP release was higher in segments from BF rats. 0.1 mmol/L L-NAME increased the response to EFS in both control and BF rats, but more so in control animals. BF decreased NO release and did not modify O2 .– production. Vasodilator response to DEA-NO was similar in both groups, while nNOS and P-nNOS expressions were decreased in segments from BF animals. Conclusion Breast feeding increases EFS-induced contraction in mesenteric arteries, mainly through the decrease of neuronal NO release mediated by decreased nNOS and P-nNOS expression. Sympathetic function is increased through the increased ATP release in BF rats. PMID:23342008

Effect of Fennel on the Health Status of Menopausal Women: A Systematic and Meta-analysis

PubMed Central

Khadivzadeh, Talat; Najafi, Mona Najaf; Kargarfard, Leila; Dizavandi, Fatemeh Rajab; Khorsand, Imaneh

2018-01-01

Objectives The aim of the present study is the systematic and critical investigation of the effectiveness of fennel on the climacteric symptoms among menopausal females. Methods A search of the trials studying the effect of fennel on menopausal females was conducted in 2017 using the MEDLINE and Scopus databases and the Cochrane Library with the following keywords: fennel, Foeniculum vulgare, and menopause. Results Fennel combined with officinalis is more effective in the attenuating of sleep disorders compared to Citalopram. The comparison of these two groups regarding the mean bone mineral density and bone mineral content (P = 0.14, P = 0.504); the total hip femoral (P = 0.42, P = 0.66); the trochanter (P = 0.075, P = 0.07); the intertrochanter (P = 0.84, P = 0.93); and the femoral neck (P = 0.43, P = 0.64) did not show any significant statistical differences; however, a statistically significant difference regarding the vasomotor symptoms (P < 0.01) was found. The other significant differences are related to the values of the total cholesterol (P = 0.103); low-density lipoprotein cholesterol, or LDL-C (P = 0.104); high-density lipoprotein cholesterol, or HDL-C (P = 0.266); triglyceride (P = 0.679); body weight (P = 0.212); body mass index (P = 0.041); waist and hip circumferences (P = 0.365); and fat distribution (P = 0.337) between the two groups. The standardized mean difference (SMD) values of sexual activity (SMD = 0.638; P < 0.001), and maturation value (SMD = 0.601; P = 0.003) are highly significant among the fennel-treated women compared with the placebo group. Conclusions According to the findings of the present study, fennel is important in the relieving of vasomotor symptoms, vaginal itching, dryness, dyspareunia, sexual function, sexual satisfaction, and sleep distribution. PMID:29765930

Impact of the severity of vasomotor symptoms on health status, resource use, and productivity.

PubMed

Whiteley, Jennifer; Wagner, Jan-Samuel; Bushmakin, Andrew; Kopenhafer, Lewis; Dibonaventura, Marco; Racketa, Jill

2013-05-01

The current study characterizes health-related quality of life, work productivity, and resource use among postmenopausal women by severity of vasomotor symptoms (VMS). Participants were selected from the 2010 US National Health and Wellness Survey. Women aged 40 to 75 years who did not report a history of menstrual bleeding or spotting for 1 year were eligible for analysis (N = 3,267). Cohorts of women with no VMS (n = 1,740), mild VMS (n = 931), moderate VMS (n = 462), and severe VMS (n = 134) were compared after controlling for demographic and health characteristics. Outcome measures were assessed using linear models and included health status, work productivity within the past 7 days, and healthcare resource use within the past 6 months. The mean age of women experiencing severe VMS was 57.92 years. After demographic and health characteristics had been controlled for, women experiencing severe and moderate VMS reported significantly lower mean health status scores compared with women with no symptoms (P < 0.0001). The mean number of menopause symptom-related physician visits was significantly greater among women with severe, moderate, or mild symptoms than among women with no symptoms (P < 0.0001). Among employed women experiencing VMS, women with severe and moderate symptoms had adjusted presenteeism of 24.28% and 14.3%, versus 4.33% in women with mild symptoms (P < 0.001), and activities of daily living impairment of 31.66% and 17.06%, versus 6.16% in women with mild symptoms (P < 0.0001). In postmenopausal women, a greater severity of VMS is significantly associated with lower levels of health status and work productivity, and greater healthcare resource use.

Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial.

PubMed

Kai, Yuko; Nagamatsu, Toshiya; Kitabatake, Yoshinori; Sensui, Hiroomi

2016-08-01

Exercise may help alleviate menopausal and depressive symptoms in middle-aged women, but sufficient evidence does not currently exist to fully support this theory. Whereas frequent moderate- to vigorous-intensity exercise may be associated with the risk of menopausal hot flashes, light-intensity exercise, such as stretching, is not likely to increase the occurrence of hot flashes. Little is, however, known about the effects of light-intensity exercise on menopausal and depressive symptoms. We examined the effects of a 3-week stretching program on the menopausal and depressive symptoms in middle-aged, Japanese women. Forty Japanese women, aged 40 to 61 years, were recruited (mean age, 51.1 ± 7.3 y). The participants were randomly assigned to either a stretching or a control group. The stretching group (n = 20) participated in a 3-week intervention program that involved 10 minutes of daily stretching, just before bedtime. The control group (n = 20) was assigned to a waiting list. Menopausal symptoms were evaluated using the Simplified Menopausal Index, which measures vasomotor, psychological, and somatic symptoms. Depressive symptoms were assessed using the Self-Rating Depression Scale. The compliance rate was 75.8% during the 3-week intervention program. The total Simplified Menopausal Index scores, including the vasomotor, psychological, and somatic symptoms, and the Self-Rating Depression Scale scores significantly decreased in the stretching group compared with that in the control group. No adverse events, including increased hot flashes, were reported by the participants during the study period. These findings suggest that 10 minutes of stretching before bedtime decreases menopausal and depressive symptoms in middle-aged, Japanese women.

Obesity and its relation to depressive symptoms and sedentary lifestyle in middle-aged women.

PubMed

Blümel, Juan E; Chedraui, Peter; Aedo, Sócrates; Fica, Juan; Mezones-Holguín, Edward; Barón, Germán; Bencosme, Ascanio; Benítez, Zully; Bravo, Luz M; Calle, Andrés; Flores, Daniel; Espinoza, María T; Gómez, Gustavo; Hernández-Bueno, José A; Laribezcoa, Fiorella; Martino, Mabel; Lima, Selva; Monterrosa, Alvaro; Mostajo, Desiree; Ojeda, Eliana; Onatra, William; Sánchez, Hugo; Tserotas, Konstatinos; Vallejo, María S; Witis, Silvina; Zúñiga, María C

2015-01-01

The prevalence of obesity increases during female mid-life and although many factors have been identified, data from Latin America is lacking. To assess factors related to obesity among middle-aged women and determine the association with depressive symptoms, sedentary lifestyle and other factors. A total of 6079 women aged 40-59 years of 11 Latin American countries were asked to fill out the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index and a general questionnaire containing personal socio-demographic data, anthropometric measures and lifestyle information. Obesity was defined as a body mass index (BMI) ≥30 kg/m(2). Obesity was observed in 18.5% and sedentary lifestyle in 63.9%. A 55.5% presented vasomotor symptoms, 12.2% had severe menopausal symptoms and 13.2% used hormone therapy for the menopause. Prevalence of depressive symptoms was 46.5% and anxiety 59.7%. Our logistic regression model found that significant factors associated to obesity included: arterial hypertension (OR: 1.87), depressive symptoms (OR: 1.57), sedentary lifestyle (OR: 1.50) diabetes mellitus (OR: 1.34), higher number of individuals living at home (OR: 1.31), sleep problems (OR:1.22), anxiety (OR: 1.21), having a stable partner (OR: 1.20), parity (OR: 1.16) and vasomotor symptoms (OR:1.14). A lower risk for obesity was found among women using hormonal contraceptives (OR: 0.69). Obesity in middle-aged women is the consequence of the interaction of multiple factors. It was associated to hypertension, depressive symptoms, sedentary lifestyle, climacteric symptoms and other factors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The chronic infusion of hexamethonium and phenylephrine to effectively clamp sympathetic vasomotor tone. A novel approach.

PubMed

Collister, J P; Osborn, J W

1999-11-01

There are several ways to assess the sympathetic nervous system (i.e. , nerve recording, sympathectomy, etc.), each of which has its own limitations. The present study was conducted to establish a standard, testable chronic ganglionic blockade protocol with a fixed level of adrenergic vasomotor tone. Rats were instrumented with radio telemetry pressure transducers and venous catheters for continuous measurement of arterial pressure and infusion of pharmacologic agents, respectively. After 3 days of control measurements, rats were infused for 9 days with a continuous dose of the ganglionic blocking agent, hexamethonium and the alpha-adrenergic agonist, phenylephrine. In this way, sympathetic tone was effectively "clamped," which maintained a normal level of arterial pressure. Control pressure between hexamethonium + phenylephrine (HEX + PE) treated rats (101+/-2 mm Hg) and saline (VEHICLE) treated rats (101+/-2 mmHg) was not different. By day 9 of the infusion, there was no difference in arterial pressure between groups (VEHICLE: 101+/-3 mm Hg, HEX + PE: 103+/-3 mm Hg) or from the control period, although heart rate was significantly less in HEX + PE rats (VEHICLE: 406+/-9 beats/min vs. HEX + PE: 343+/-6 beats/min). The effectiveness of this technique was validated by measuring cardiac baroreceptor reflex sensitivity, as well as the pressor response to the direct ganglionic stimulating agent, 1, 1-dimethyl-4-phenylpiperazinium iodide (DMPP). Compared to VEHICLE rats, HEX + PE rats showed no tachycardic response to depressor stimuli and an absence of a pressor response to DMPP. We conclude that this protocol is a useful technique to chronically, yet reversibly, block the sympathetic nervous system in experimental settings.

Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women's Health Across the Nation.

PubMed

Thurston, Rebecca C; El Khoudary, Samar R; Tepper, Ping Guo; Jackson, Elizabeth A; Joffe, Hadine; Chen, Hsiang-Yu; Matthews, Karen A

2016-01-01

Emerging work has linked menopausal vasomotor symptoms (VMS) to subclinical cardiovascular disease (CVD) among women. However, VMS are dynamic over time. No studies have considered how temporal patterns of VMS may relate to subclinical CVD. We tested how temporal patterns of VMS assessed over 13 years were related to carotid intima media thickness (IMT) among midlife women. The Study of Women's Health Across the Nation is a longitudinal cohort study of midlife women. Eight hundred and eleven white, black, Hispanic, and Chinese participants with a well-characterized final menstrual period completed measures of VMS, a blood draw, and physical measures approximately annually for 13 years. Women underwent a carotid artery ultrasound at study visit 12. Four trajectories of VMS were identified by trajectory analysis (consistently high, early-onset, late-onset, persistently low VMS) and tested in relation to carotid indices in linear regression models. Results indicated that women with early-onset VMS had both greater mean IMT (beta, b [standard error, SE]=0.03 [0.01], P=0.03) and greater maximal IMT (b [SE]=0.04 [0.01], P=0.008) than women with consistently low VMS, adjusting for demographics and CVD risk factors. This is the first study to test trajectories of VMS in relation to subclinical CVD. Women with VMS early in the menopause transition had higher mean IMT and maximal IMT than those with consistently low VMS across the transition. Associations were not accounted for by demographic factors nor by CVD risk factors. Results can signal to women in need of early CVD risk reduction. © 2015 American Heart Association, Inc.

A Comparison of Oral Sensory Effects of Three TRPA1 Agonists in Young Adult Smokers and Non-smokers

PubMed Central

Hansen, Eva Ø.; Arendt-Nielsen, Lars; Boudreau, Shellie A.

2017-01-01

This study profiled intra-oral somatosensory and vasomotor responses to three different transient receptor potential (TRP) channels, subfamily A, member 1 (TRPA1) agonists (menthol, nicotine, and cinnamaldehyde) in smoking and non-smoking young adults. Healthy non-smokers (N = 30) and otherwise healthy smokers (N = 25) participated in a randomized, double-blinded, cross-over study consisting of three experimental sessions in which they received menthol (30 mg), nicotine (4 mg), or cinnamaldehyde (25 mg) chewing gum. Throughout a standardized 10 min chewing regime, burning, cooling, and irritation intensities, and location were recorded. In addition, blood pressure, heart rate and intra-oral temperature were assessed before, during, and after chewing. Basal intra-oral temperature was lower in smokers (35.2°C ± 1.58) as compared to non-smokers (35.9°C ± 1.61) [F(1, 52) = 8.5, P = 0.005, post hoc, p = 0.005]. However, the increase in temperature, heart rate, and blood pressure in response to chewing menthol, nicotine, and cinnamaldehyde gums were similar between smokers and non-smokers. Although smoking status did not influence the intensity of burning, cooling, and irritation, smokers did report nicotine burn more often (92%) than non-smokers (63%) [χ(1, N=55)2 = 6.208, P = 0.013]. Reports of nicotine burn consistently occurred at the back of the throat and cinnamaldehyde burn on the tongue. The cooling sensation of menthol was more widely distributed in the mouth of non-smokers as compared to smokers. Smoking alters thermoregulation, somatosensory, and possibly TRPA1 receptor responsiveness and suggests that accumulated exposure of nicotine by way of cigarette smoke alters oral sensory and vasomotor sensitivity. PMID:28936178

Effects of stretching on menopausal and depressive symptoms in middle-aged women: a randomized controlled trial

PubMed Central

Kai, Yuko; Nagamatsu, Toshiya; Kitabatake, Yoshinori; Sensui, Hiroomi

2016-01-01

Abstract Objective: Exercise may help alleviate menopausal and depressive symptoms in middle-aged women, but sufficient evidence does not currently exist to fully support this theory. Whereas frequent moderate- to vigorous-intensity exercise may be associated with the risk of menopausal hot flashes, light-intensity exercise, such as stretching, is not likely to increase the occurrence of hot flashes. Little is, however, known about the effects of light-intensity exercise on menopausal and depressive symptoms. We examined the effects of a 3-week stretching program on the menopausal and depressive symptoms in middle-aged, Japanese women. Methods: Forty Japanese women, aged 40 to 61 years, were recruited (mean age, 51.1 ± 7.3 y). The participants were randomly assigned to either a stretching or a control group. The stretching group (n = 20) participated in a 3-week intervention program that involved 10 minutes of daily stretching, just before bedtime. The control group (n = 20) was assigned to a waiting list. Menopausal symptoms were evaluated using the Simplified Menopausal Index, which measures vasomotor, psychological, and somatic symptoms. Depressive symptoms were assessed using the Self-Rating Depression Scale. Results: The compliance rate was 75.8% during the 3-week intervention program. The total Simplified Menopausal Index scores, including the vasomotor, psychological, and somatic symptoms, and the Self-Rating Depression Scale scores significantly decreased in the stretching group compared with that in the control group. No adverse events, including increased hot flashes, were reported by the participants during the study period. Conclusions: These findings suggest that 10 minutes of stretching before bedtime decreases menopausal and depressive symptoms in middle-aged, Japanese women. PMID:27300113

Shaker-related voltage-gated K+ channel expression and vasomotor function in human coronary resistance arteries.

PubMed

Nishijima, Yoshinori; Korishettar, Ankush; Chabowski, Dawid S; Cao, Sheng; Zheng, Xiaodong; Gutterman, David D; Zhang, David X

2018-01-01

K V channels are important regulators of vascular tone, but the identity of specific K V channels involved and their regulation in disease remain less well understood. We determined the expression of K V 1 channel subunits and their role in cAMP-mediated dilation in coronary resistance arteries from subjects with and without CAD. HCAs from patients with and without CAD were assessed for mRNA and protein expression of K V 1 channel subunits with molecular techniques and for vasodilator response with isolated arterial myography. Assays of mRNA transcripts, membrane protein expression, and vascular cell-specific localization revealed abundant expression of K V 1.5 in vascular smooth muscle cells of non-CAD HCAs. Isoproterenol and forskolin, two distinct cAMP-mediated vasodilators, induced potent dilation of non-CAD arterioles, which was inhibited by both the general K V blocker 4-AP and the selective K V 1.5 blocker DPO-1. The cAMP-mediated dilation was reduced in CAD and was accompanied by a loss of or reduced contribution of 4-AP-sensitive K V channels. K V 1.5, as a major 4-AP-sensitive K V 1 channel expressed in coronary VSMCs, mediates cAMP-mediated dilation in non-CAD arterioles. The cAMP-mediated dilation is reduced in CAD coronary arterioles, which is associated with impaired 4-AP-sensitive K V channel function. © 2017 John Wiley & Sons Ltd.

Zolpidem arousing effect in persistent vegetative state patients: autonomic, EEG and behavioral assessment.

PubMed

Machado, Calixto; Estévez, Mario; Rodríguez, Rafael; Pérez-Nellar, Jesús; Chinchilla, Mauricio; DeFina, Philip; Leisman, Gerry; Carrick, Frederick R; Melillo, Robert; Schiavi, Adam; Gutiérrez, Joel; Carballo, Maylén; Machado, Andrés; Olivares, Ana; Pérez-Cruz, Nuvia

2014-01-01

To study the Zolpidem arousing effect in persistent vegetative state (PVS) patients combining clinical evaluation, autonomic assessment by heart rate variability (HRV), and EEG records. We studied a group of 8 PVS patients and other 8 healthy control subjects, matched by age and gender. The patients and controls received drug or placebo in two experimental sessions, separated by 10-14 days. The first 30 minutes of the session were considered the basal record, and then Zolpidem was administered. All participants were evaluated clinically, by EEG, and by HRV during the basal record, and for 90 minutes after drug intake. We found in all patients, time-related arousing signs after Zolpidem intake: behavioral (yawns and hiccups), activation of EEG cortical activity, and a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone. We demonstrated time-related arousing signs after Zolpidem intake. We discussed possible mechanisms to explain these patho-physiological findings regarding EEG cortical activation and an autonomic vagolytic drug effect. As this autonomic imbalance might induce cardiocirculatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that this arousing Zolpidem effect might be certainly related to brain function improvement, it should be particularly considered for the development of new neuro-rehabilitation programs in PVS cases. According to the literature review, we claim that this is the first report about the vagolitic effect of Zolpidem in PVS cases.

Electrolytes and thermoregulation

NASA Technical Reports Server (NTRS)

Nielsen, B.; Greenleaf, J. E.

1977-01-01

The influence of ions on temperature is studied for cases where the changes in ionic concentrations are induced by direct infusion or injection of electrolyte solutions into the cerebral ventricles or into specific areas of brain tissue; intravenous infusion or injection; eating food or drinking solutions of different ionic composition; and heat or exercise dehydration. It is shown that introduction of Na(+) and Ca(++) into the cerebral ventricles or into the venous system affects temperature regulation. It appears that the specific action of these ions is different from their osmotic effects. It is unlikely that their action is localized to the thermoregulatory centers in the brain. The infusion experiments demonstrate that the changes in sodium balance occurring during exercise and heat stress are large enough to affect sweat gland function and vasomotor activity.

Prevalence of hot flushes and night sweats around the world: a systematic review.

PubMed

Freeman, E W; Sherif, K

2007-06-01

Many studies have evaluated the relationships between ethnicity and culture, prevalence of menopausal symptoms, and attitudes toward them, but few have assessed menopausal symptoms across cultures world-wide. This paper aims to systematically review the prevalence of hot flushes and night sweats, two prevalent symptoms of menopause, across the menopausal stages in different cultures and considers potential explanations for differences in prevalence rates. Sixty-six papers formed the basis for this review. Studies were organized by geographic region, and results are presented for North America, Europe, East Asia, Southeast Asia, Australia, Latin America, South Asia, Middle East, and Africa. Studies were included if they provided quantitative information on the occurrence of hot flushes. This report focuses on hot flushes and night sweats, the most common menopausal symptoms reported in epidemiologic studies. Studies reviewed indicate that vasomotor symptoms are highly prevalent in most societies. The prevalence of these symptoms varies widely and may be influenced by a range of factors, including climate, diet, lifestyle, women's roles, and attitudes regarding the end of reproductive life and aging. Patterns in hot flush prevalence were apparent for menopausal stages and, to a lesser degree, for regional variation. Caregivers should recognize that variations exist and ask patients specific questions about symptoms and their impact on usual functioning.

Axillary Brachial Plexus Blockade for the Reflex Sympathetic Dystrophy Syndrome.

ERIC Educational Resources Information Center

Ribbers, G. M.; Geurts, A. C. H.; Rijken, R. A. J.; Kerkkamp, H. E. M.

1997-01-01

Reflex sympathetic dystrophy syndrome (RSD) is a neurogenic pain syndrome characterized by pain, vasomotor and dystrophic changes, and often motor impairments. This study evaluated the effectiveness of brachial plexus blockade with local anaesthetic drugs as a treatment for this condition. Three patients responded well; three did not. (DB)

Introduction à L'Etude de la Médecine Expérimentale. Surgical revolution. Part I.

PubMed

Toledo-Pereyra, Luis H

2009-01-01

Claude Bernard (1813-1878), the most distinguished French physiologist of the 19th century, made incomparable contributions to the world of medicine of his times and even to ours. Bernard believed in scientific determinism and created the term milieu interieur as a manner to better understand experimental medicine and to present a new way of explaining the function of the living organism. Bernard dealt with innovative developments in the glycogenetic function of the liver, extrahepatic glycogenesis, the role of pancreatic juice in the digestion of fats, vasomotor nervous system discoveries, and other important physiological advances. In 1865, Bernard's most extraordinary book on the philosophy and understanding of experimental medicine appeared. This book represented Bernard's unique contribution to the progress of medical and surgical research. Because of the enormous implications of this work on the advancement of surgical research, which were subsequently applied to clinical surgical practice, we propose that this book created a surgical revolution.

Effects of aging and exercise training on spinotrapezius muscle microvascular Po2 dynamics and vasomotor control

PubMed Central

McCullough, Danielle J.; Davis, Robert T.; Dominguez, James M.; Stabley, John N.; Bruells, Christian S.

2011-01-01

With advancing age, there is a reduction in exercise tolerance, resulting, in part, from a perturbed ability to match O2 delivery to uptake within skeletal muscle. In the spinotrapezius muscle (which is not recruited during incline treadmill running) of aged rats, we tested the hypotheses that exercise training will 1) improve the matching of O2 delivery to O2 uptake, evidenced through improved microvascular Po2 (PmO2), at rest and throughout the contractions transient; and 2) enhance endothelium-dependent vasodilation in first-order arterioles. Young (Y, ∼6 mo) and aged (O, >24 mo) Fischer 344 rats were assigned to control sedentary (YSED; n = 16, and OSED; n = 15) or exercise-trained (YET; n = 14, and OET; n = 13) groups. Spinotrapezius blood flow (via radiolabeled microspheres) was measured at rest and during exercise. Phosphorescence quenching was used to quantify PmO2 in vivo at rest and across the rest-to-twitch contraction (1 Hz, 5 min) transition in the spinotrapezius muscle. In a follow-up study, vasomotor responses to endothelium-dependent (acetylcholine) and -independent (sodium nitroprusside) stimuli were investigated in vitro. Blood flow to the spinotrapezius did not increase above resting values during exercise in either young or aged groups. Exercise training increased the precontraction baseline PmO2 (OET 37.5 ± 3.9 vs. OSED 24.7 ± 3.6 Torr, P < 0.05); the end-contracting PmO2 and the time-delay before PmO2 fell in the aged group but did not affect these values in the young. Exercise training improved maximal vasodilation in aged rats to acetylcholine (OET 62 ± 16 vs. OSED 27 ± 16%) and to sodium nitroprusside in both young and aged rats. Endurance training of aged rats enhances the PmO2 in a nonrecruited skeletal muscle and is associated with improved vascular smooth muscle function. These data support the notion that improvements in vascular function with exercise training are not isolated to the recruited muscle. PMID:21212242

Effects of acetazolamide on the micro- and macro-vascular cerebral hemodynamics: a diffuse optical and transcranial doppler ultrasound study

PubMed Central

Zirak, Peyman; Delgado-Mederos, Raquel; Martí-Fàbregas, Joan; Durduran, Turgut

2010-01-01

Acetazolamide (ACZ) was used to stimulate the cerebral vasculature on ten healthy volunteers to assess the cerebral vasomotor reactivity (CVR). We have combined near infrared spectroscopy (NIRS), diffuse correlation spectroscopy (DCS) and transcranial Doppler (TCD) technologies to non-invasively assess CVR in real-time by measuring oxy- and deoxy-hemoglobin concentrations, using NIRS, local cerebral blood flow (CBF), using DCS, and blood flow velocity (CBFV) in the middle cerebral artery, using TCD. Robust and persistent increases in oxy-hemoglobin concentration, CBF and CBFV were observed. A significant agreement was found between macro-vascular (TCD) and micro-vascular (DCS) hemodynamics, between the NIRS and TCD data, and also within NIRS and DCS results. The relative cerebral metabolic rate of oxygen, rCMRO2, was also determined, and no significant change was observed. Our results showed that the combined diffuse optics-ultrasound technique is viable to follow (CVR) and rCMRO2 changes in adults, continuously, at the bed-side and in real time. PMID:21258561

Effects of acetazolamide on the micro- and macro-vascular cerebral hemodynamics: a diffuse optical and transcranial doppler ultrasound study.

PubMed

Zirak, Peyman; Delgado-Mederos, Raquel; Martí-Fàbregas, Joan; Durduran, Turgut

2010-11-19

Acetazolamide (ACZ) was used to stimulate the cerebral vasculature on ten healthy volunteers to assess the cerebral vasomotor reactivity (CVR). We have combined near infrared spectroscopy (NIRS), diffuse correlation spectroscopy (DCS) and transcranial Doppler (TCD) technologies to non-invasively assess CVR in real-time by measuring oxy- and deoxy-hemoglobin concentrations, using NIRS, local cerebral blood flow (CBF), using DCS, and blood flow velocity (CBFV) in the middle cerebral artery, using TCD. Robust and persistent increases in oxy-hemoglobin concentration, CBF and CBFV were observed. A significant agreement was found between macro-vascular (TCD) and micro-vascular (DCS) hemodynamics, between the NIRS and TCD data, and also within NIRS and DCS results. The relative cerebral metabolic rate of oxygen, rCMRO(2), was also determined, and no significant change was observed. Our results showed that the combined diffuse optics-ultrasound technique is viable to follow (CVR) and rCMRO(2) changes in adults, continuously, at the bed-side and in real time.

Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control

NASA Technical Reports Server (NTRS)

Furlan, R.; Jacob, G.; Snell, M.; Robertson, D.; Porta, A.; Harris, P.; Mosqueda-Garcia, R.

1998-01-01

BACKGROUND: Chronic orthostatic intolerance (COI) is a debilitating autonomic condition in young adults. Its neurohumoral and hemodynamic profiles suggest possible alterations of postural sympathetic function and of baroreflex control of heart rate (HR). METHODS AND RESULTS: In 16 COI patients and 16 healthy volunteers, intra-arterial blood pressure (BP), ECG, central venous pressure (CVP), and muscle sympathetic nerve activity (MSNA) were recorded at rest and during 75 degrees tilt. Spectral analysis of RR interval and systolic arterial pressure (SAP) variabilities provided indices of sympathovagal modulation of the sinoatrial node (ratio of low-frequency to high-frequency components, LF/HF) and of sympathetic vasomotor control (LFSAP). Baroreflex mechanisms were assessed (1) by the slope of the regression line obtained from changes of RR interval and MSNA evoked by pharmacologically induced alterations in BP and (2) by the index alpha, obtained from cross-spectral analysis of RR and SAP variabilities. At rest, HR, MSNA, LF/HF, and LFSAP were higher in COI patients, whereas BP and CVP were similar in the two groups. During tilt, BP did not change and CVP fell by the same extent in the 2 groups; the increase of HR and LF/HF was more pronounced in COI patients. Conversely, the increase of MSNA was lower in COI than in control subjects. Baroreflex sensitivity was similar in COI and control subjects at rest; tilt reduced alpha similarly in both groups. CONCLUSIONS: COI is characterized by an overall enhancement of noradrenergic tone at rest and by a blunted postganglionic sympathetic response to standing, with a compensatory cardiac sympathetic overactivity. Baroreflex mechanisms maintain their functional responsiveness. These data suggest that in COI, the functional distribution of central sympathetic tone to the heart and vasculature is abnormal.

Isoflavones, calcium, vitamin D and inulin improve quality of life, sexual function, body composition and metabolic parameters in menopausal women: result from a prospective, randomized, placebo-controlled, parallel-group study

PubMed Central

Caruso, Salvatore; Rapisarda, Agnese Maria Chiara; Cianci, Stefano; Cianci, Antonio

2018-01-01

Introduction Menopause results in metabolic changes that contribute to increase risk of cardiovascular diseases: increase in low density lipoprotein (LDL) and triglycerides and decrease in high density lipoprotein (HDL), weight gain are associated with a correspondent increase in incidence of hypertension and diabetes. The aim of this study was to evaluate the effect of a preparation of isoflavones, calcium vitamin D and inulin in menopausal women. Material and methods We performed a prospective, randomized, placebo-controlled, parallel-group study. A total of 50 patients were randomized to receive either oral preparations of isoflavones (40 mg), calcium (500 mg) vitamin D (300 UI) and inulin (3 g) or placebo (control group). Pre- and post-treatment assessment of quality of life and sexual function were performed through Menopause-Specific Quality of Life Questionnaire (MENQOL) and Female Sexual Function Index (FSFI); evaluations of anthropometric indicators, body composition through bioelectrical impedance analyser, lumbar spine and proximal femur T-score and lipid profile were performed. Results After 12 months, a significant reduction in MENQOL vasomotor, physical and sexual domain scores (p < 0.05) and a significant increase in all FSFI domain scores (p < 0.05) were observed in treatment group. Laboratory tests showed significant increase in serum levels of HDL (p < 0.05). No significant changes of lumbar spine and femur neck T-score (p > 0.05) were found in the same group. Conclusions According to our data analysis, isoflavones, calcium, vitamin D and inulin may exert favourable effects on menopausal symptoms and signs. PMID:29725283

Development of Sensitive and Direct Methods for Measuring Plasma Aldosterone and Catecholamine Concentrations

NASA Technical Reports Server (NTRS)

Haber, E.

1972-01-01

Radioimmunoassays for renin activity, angiotensin 1, and angiotensin 2 in the study of vasomotor regulation give new insight into the role of the renin system in maintaining postural homeostatsis. Similar laboratory procedures for specific assays of aldosterone and catecholamines achieve accurate determinations in small human blood samples.

Spinal Cord Injury-Induced Dysautonomia via Plasticity in Paravertebral Sympathetic Postganglionic

DTIC Science & Technology

2016-10-01

sympathetic chain of the guinea - pig . J Physiol 203:173-198. Bratton B, Davies P, Janig W, McAllen R (2010) Ganglionic transmission in a vasomotor...sympathetic neurons. Journal of neurophysiology 82:2747-2764. Lichtman JW, Purves D, Yip JW (1980) Innervation of sympathetic neurones in the guinea - pig ...10 6. PRODUCTS

Vasomotor tone does not affect perfusion heterogeneity and gas exchange in normal primate lungs during normoxia

NASA Technical Reports Server (NTRS)

Glenny, R. W.; Robertson, H. T.; Hlastala, M. P.

2000-01-01

To determine whether vasoregulation is an important cause of pulmonary perfusion heterogeneity, we measured regional blood flow and gas exchange before and after giving prostacyclin (PGI(2)) to baboons. Four animals were anesthetized with ketamine and mechanically ventilated. Fluorescent microspheres were used to mark regional perfusion before and after PGI(2) infusion. The lungs were subsequently excised, dried inflated, and diced into approximately 2-cm(3) pieces (n = 1,208-1,629 per animal) with the spatial coordinates recorded for each piece. Blood flow to each piece was determined for each condition from the fluorescent signals. Blood flow heterogeneity did not change with PGI(2) infusion. Two other measures of spatial blood flow distribution, the fractal dimension and the spatial correlation, did not change with PGI(2) infusion. Alveolar-arterial O(2) differences did not change with PGI(2) infusion. We conclude that, in normal primate lungs during normoxia, vasomotor tone is not a significant cause of perfusion heterogeneity. Despite the heterogeneous distribution of blood flow, active regulation of regional perfusion is not required for efficient gas exchange.

Genetic testing for hereditary cancer predisposition: BRCA1/2, Lynch syndrome, and beyond

PubMed Central

Hall, MJ; Obeid, EI; Schwartz, SC; Mantia-Smaldone, G; Forman, AD; Daly, MB

2016-01-01

Obstetrician/gynecologists and gynecologic oncologists serve an integral role in the care of women at increased hereditary risk of cancer. Their contribution includes initial identification of high risk patients, screening procedures like bimanual exam, trans-vaginal ultrasound and endometrial biopsy, prophylaxis via TAH and/or BSO, and chemoprevention. Further, gynecologists also serve a central role in the management of the secondary repercussions of efforts to mitigate increased cancer risks, including vasomotor symptoms, sexual function, bone health, cardiovascular disease, and mental health. The past several years has seen multiple new high and moderate penetrance genes introduced into the clinical care of women at increased risk of gynecologic malignancy. Awareness of these new genes and the availability of new multigene panel tests is critical for providers on the front-line of women’s health. PMID:26812021

Upregulation of FLJ10540, a PI3K-association protein, in rostral ventrolateral medulla impairs brain stem cardiovascular regulation during mevinphos intoxication.

PubMed

Tsai, Ching-Yi; Chen, Chang-Han; Chang, Alice Y W; Chan, Julie Y H; Chan, Samuel H H

2015-01-01

FLJ10540, originally identified as a microtubule-associated protein, induces cell proliferation and migration during tumorigenesis via the formation of FLJ10540-PI3K complex and enhancement of PI3K kinase activity. Interestingly, activation of PI3K/Akt cascade, leading to upregulation of nitric oxide synthase II (NOS II)/peroxynitrite signaling in the rostral ventrolateral medulla (RVLM), the brain stem site that maintains blood pressure and sympathetic vasomotor tone, mediates the impairment of brain stem cardiovascular regulation induced by the pesticide mevinphos. We evaluated the hypothesis that upregulation of FLJ10540 in the RVLM is upstream to this repertoire of signaling cascade that underpins mevinphos-induced circulatory depression. Microinjection bilaterally of mevinphos (10nmol) into the RVLM of anesthetized Sprague-Dawley rats induced a progressive hypotension that was accompanied by an increase (Phase I), followed by a decrease (Phase II) of an experimental index for baroreflex-mediated sympathetic vasomotor tone. There was augmentation in FLJ10540 mRNA in the RVLM or FLJ10540 protein in RVLM neurons, both of which were causally and temporally related to an augmentation of binding between the catalytic subunit (p110) and regulatory subunit (p85) of PI3K, phosphorylation of Akt at Thr308 site, and NOS II, superoxide or peroxynitrite level in the RVLM. Immunoneutralization of FJL10540 in the RVLM significantly antagonized those biochemical changes, and blunted the progressive hypotension and the reduced baroreflex-mediated sympathetic vasomotor tone during mevinphos intoxication. We conclude that upregulation of FLJ10540 in the RVLM elicits impairment of brain stem cardiovascular regulation that underpins circulatory depression during mevinphos intoxication via activation of PI3K/Akt/NOS II/peroxynitrite signaling cascade in the RVLM. Copyright © 2014 Elsevier Inc. All rights reserved.

Role of Multimodal Evaluation of Cerebral Hemodynamics in Selecting Patients with Symptomatic Carotid or Middle Cerebral Artery Steno-occlusive Disease for Revascularization

PubMed Central

Sharma, Vijay K; Tsivgoulis, Georgios; Ning, Chou; Teoh, Hock L; Bairaktaris, Chrisostomos; Chong, Vincent FH; Ong, Benjamin KC; Chan, Bernard PL; Sinha, Arvind K

2008-01-01

Background: The circle of Willis provides collateral pathways to perfuse the affected vascular territories in patients with severe stenoocclusive disease of major arteries. The collateral perfusion may become insufficient in certain physiological circumstances due to failed vasodilatory reserve and intracranial steal phenomenon, so-called ‘Reversed-Robinhood syndrome’. We evaluated cerebral hemodynamics and vasodilatory reserve in patients with symptomatic distal internal carotid (ICA) or middle cerebral artery (MCA) severe steno-occlusive disease. Methods: Diagnostic transcranial Doppler (TCD) and TCD-monitoring with voluntary breath-holding according to a standard scanning protocol were performed in patients with severe ICA or MCA steno-occlusive disease. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. Patients with exhausted vasomotor reactivity and intracranial steal phenomenon during breath-holding were further evaluated by 99technetiumm-hexamethyl propylene amine oxime single photon emission computed tomography (HMPAO-SPECT) with acetazolamide challenge. Results: Sixteen patients (age 27–74 years, 11 men) fulfilled our TCD criteria for exhausted vasomotor reactivity and intracranial steal phenomenon during the standard vasomotor testing by breath holding. Acetazolamide-challenged HMPAO-SPECT demonstrated significant hypoperfusion in 12 patients in affected arterial territories, suggestive of failed vasodilatory reserve. A breath-holding index of ≤0.3 on TCD was associated with an abnormal HMPAO-SPECT with acetazolamide challenge. TCD findings of a breath holding index of ≤0.3 and intracranial steal during the procedure were determinants of a significant abnormality on HMPAO-SPECT with acetazolamide challenge. Conclusion: Multimodal evaluation of cerebral hemodynamics in symptomatic patients with severe steno-occlusive disease of the ICA or MCA is helpful in the identification and quantification of failed vasodilatory reserve. This approach may be useful in selecting patients for possible revascularization procedures. PMID:22518232

Imaging the Effects of Oxygen Saturation Changes in Voluntary Apnea and Hyperventilation on Susceptibility-Weighted Imaging

PubMed Central

Chang, K.; Barnes, S.; Haacke, E.M.; Grossman, R.I.; Ge, Y.

2014-01-01

BACKGROUND AND PURPOSE Cerebrovascular oxygenation changes during respiratory challenges have clinically important implications for brain function, including cerebral autoregulation and the rate of brain metabolism. SWI is sensitive to venous oxygenation level by exploitation of the magnetic susceptibility of deoxygenated blood. We assessed cerebral venous blood oxygenation changes during simple voluntary breath-holding (apnea) and hyperventilation by use of SWI at 3T. MATERIALS AND METHODS We performed SWI scans (3T; acquisition time of 1 minute, 28 seconds; centered on the anterior commissure and the posterior commissure) on 10 healthy male volunteers during baseline breathing as well as during simple voluntary hyperventilation and apnea challenges. The hyperventilation and apnea tasks were separated by a 5-minute resting period. SWI venograms were generated, and the signal changes on SWI before and after the respiratory stress tasks were compared by means of a paired Student t test. RESULTS Changes in venous vasculature visibility caused by the respiratory challenges were directly visualized on the SWI venograms. The venogram segmentation results showed that voluntary apnea decreased the mean venous blood voxel number by 1.6% (P<.0001), and hyperventilation increased the mean venous blood voxel number by 2.7% (P<.0001). These results can be explained by blood CO2 changes secondary to the respiratory challenges, which can alter cerebrovascular tone and cerebral blood flow and ultimately affect venous oxygen levels. CONCLUSIONS These results highlight the sensitivity of SWI to simple and noninvasive respiratory challenges and its potential utility in assessing cerebral hemodynamics and vasomotor responses. PMID:24371029

Imaging the effects of oxygen saturation changes in voluntary apnea and hyperventilation on susceptibility-weighted imaging.

PubMed

Chang, K; Barnes, S; Haacke, E M; Grossman, R I; Ge, Y

2014-06-01

Cerebrovascular oxygenation changes during respiratory challenges have clinically important implications for brain function, including cerebral autoregulation and the rate of brain metabolism. SWI is sensitive to venous oxygenation level by exploitation of the magnetic susceptibility of deoxygenated blood. We assessed cerebral venous blood oxygenation changes during simple voluntary breath-holding (apnea) and hyperventilation by use of SWI at 3T. We performed SWI scans (3T; acquisition time of 1 minute, 28 seconds; centered on the anterior commissure and the posterior commissure) on 10 healthy male volunteers during baseline breathing as well as during simple voluntary hyperventilation and apnea challenges. The hyperventilation and apnea tasks were separated by a 5-minute resting period. SWI venograms were generated, and the signal changes on SWI before and after the respiratory stress tasks were compared by means of a paired Student t test. Changes in venous vasculature visibility caused by the respiratory challenges were directly visualized on the SWI venograms. The venogram segmentation results showed that voluntary apnea decreased the mean venous blood voxel number by 1.6% (P < .0001), and hyperventilation increased the mean venous blood voxel number by 2.7% (P < .0001). These results can be explained by blood CO2 changes secondary to the respiratory challenges, which can alter cerebrovascular tone and cerebral blood flow and ultimately affect venous oxygen levels. These results highlight the sensitivity of SWI to simple and noninvasive respiratory challenges and its potential utility in assessing cerebral hemodynamics and vasomotor responses. © 2014 by American Journal of Neuroradiology.

Yale Study: African-American Women Report More Menopause Symptoms than White Women

ERIC Educational Resources Information Center

Black Issues in Higher Education, 2005

2005-01-01

A study of African-American women in menopause shows that while they experience many of the same symptoms as White women, they report more vasomotor symptoms such as dizziness and bloating, according to a study by a Yale School of Nursing researcher. The women reported symptoms common among White women in menopause--hot flashes, irregular…

The Reflex Sympathetic Dystrophy Syndrome: A Review with Special Reference to Chronic Pain and Motor Impairments.

ERIC Educational Resources Information Center

Ribbers, G.; And Others

1995-01-01

This article reviews reflex sympathetic dystrophy (RSD), a symptom complex caused by a minor injury and characterized by pain, vasomotor and trophic disregulation, and motor impairments. Both an acute stage and a chronic stage are described. Implications for diagnosis, prevention of disabilities, and development of rehabilitation strategies are…

Nitric Oxide Contributes to Vasomotor Tone in Hypertensive African Americans Treated With Nebivolol and Metoprolol.

PubMed

Neuman, Robert B; Hayek, Salim S; Poole, Joseph C; Rahman, Ayaz; Menon, Vivek; Kavtaradze, Nino; Polhemus, David; Veledar, Emir; Lefer, David J; Quyyumi, Arshed A

2016-03-01

Endothelial dysfunction is more prevalent in African Americans (AAs) compared with whites. The authors hypothesized that nebivolol, a selective β1 -antagonist that stimulates nitric oxide (NO), will improve endothelial function in AAs with hypertension when compared with metoprolol. In a double-blind, randomized, crossover study, 19 AA hypertensive patients were randomized to a 12-week treatment period with either nebivolol 10 mg or metoprolol succinate 100 mg daily. Forearm blood flow (FBF) was measured using plethysmography at rest and after intra-arterial infusion of acetylcholine and sodium nitroprusside to estimate endothelium-dependent and independent vasodilation, respectively. Physiologic vasodilation was assessed during hand-grip exercise. Measurements were repeated after NO blockade with L-N(G) -monomethylarginine (L-NMMA) and after inhibition of endothelium-derived hyperpolarizing factor (EDHF) with tetraethylammonium chloride (TEA). NO blockade with L-NMMA produced a trend toward greater vasoconstriction during nebivolol compared with metoprolol treatment (21% vs 12% reduction in FBF, P=.06, respectively). This difference was more significant after combined administration of L-NMMA and TEA (P<.001). Similarly, there was a contribution of NO to exercise-induced vasodilation during nebivolol but not during metoprolol treatment. There were significantly greater contributions of NO and EDHF to resting vasodilator tone and of NO to exercise-induced vasodilation with nebivolol compared with metoprolol in AAs with hypertension. © 2015 Wiley Periodicals, Inc.

Nitric Oxide Contributes to Vasomotor Tone in Hypertensive African Americans Treated With Nebivolol and Metoprolol

PubMed Central

Neuman, Robert B.; Hayek, Salim; Poole, Joseph C.; Rahman, Ayaz; Menon, Vivek; Kavtaradze, Nino; Polhemus, David; Veledar, Emir; Lefer, David J.; Quyyumi, Arshed A.

2015-01-01

Endothelial dysfunction is more prevalent in African Americans (AA) compared to whites. We hypothesized that nebivolol, a selective β-1 antagonist that stimulates NO, will improve endothelial function in AA with hypertension when compared to metoprolol. In a double-blind, randomized, cross-over study, 19 AA hypertensive subjects were randomized to a 12-week treatment period with either nebivolol 10mg or metoprolol succinate 100mg daily. Forearm blood flow (FBF) was measured using plethysmography at rest and after intra-arterial infusion of acetylcholine, and sodium nitroprusside to estimate endothelium-dependent and independent vasodilation, respectively. Physiologic vasodilation was assessed during hand-grip exercise. Measurements were repeated after NO blockade with L-NG-monomethylarginine (L-NMMA), and after inhibition of endothelium-derived hyperpolarizing factor (EDHF) with tetraethylammonium chloride (TEA). NO blockade with L-NMMA produced a trend toward greater vasoconstriction during nebivolol compared to metoprolol treatment period (21% vs 12% reduction in FBF, p=0.06, respectively). This difference was more significant after combined administration of L-NMMA and TEA (p<0.001). Similarly, there was a contribution of NO to exercise-induced vasodilation during nebivolol but not during metoprolol treatment. There were significantly greater contributions of NO and EDHF to resting vasodilator tone and of NO to exercise-induced vasodilation with nebivolol compared to metoprolol in AA with hypertension. PMID:26285691

Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms

PubMed Central

Kerner, Nancy A.; Roose, Steven P.

2017-01-01

Obstructive sleep apnea (OSA) is highly prevalent but very frequently undiagnosed. OSA is an independent risk factor for depression and cognitive impairment/dementia. Herein the authors review studies in the literature pertinent to the effects of OSA on the cerebral microvascular and neurovascular systems and present a model to describe the key pathophysiologic mechanisms that may underlie the associations, including hypoperfusion, endothelial dysfunction, and neuroinflammation. Intermittent hypoxia plays a critical role in initiating and amplifying these pathologic processes. Hypoperfusion and impaired cerebral vasomotor reactivity lead to the development or progression of cerebral small vessel disease (C-SVD). Hypoxemia exacerbates these processes, resulting in white matter lesions, white matter integrity abnormalities, and gray matter loss. Blood–brain barrier (BBB) hyperpermeability and neuroinflammation lead to altered synaptic plasticity, neuronal damage, and worsening C-SVD. Thus, OSA may initiate or amplify the pathologic processes of C-SVD and BBB dysfunction, resulting in the development or exacerbation of depressive symptoms and cognitive deficits. Given the evidence that adequate treatment of OSA with continuous positive airway pressure improves depression and neurocognitive functions, it is important to identify OSA when assessing patients with depression or cognitive impairment. Whether treatment of OSA changes the deteriorating trajectory of elderly patients with already-diagnosed vascular depression and cognitive impairment/dementia remains to be determined in randomized controlled trials. PMID:27139243

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tirapelli, Carlos R.; De Andrade, Claudia R.; Lieberman, Marcel

We aimed to investigate the mechanisms underlying the vascular effects induced by phylloquinone (Vitamin K{sub 1}; VK{sub 1}). Vascular reactivity experiments, using standard muscle bath procedures, showed that VK{sub 1} (5 and 50 {mu}M) enhances the contractile response of endothelium-intact, but not denuded, rat carotid rings to phenylephrine. Similarly, maximal contraction induced by phenylephrine was enhanced in the presence of the nitric oxide (NO) synthase inhibitor N {sup G}-nitro-L-arginine methyl ester (L-NAME). The combination of L-NAME and VK{sub 1} did not produce any further additional effect. Pre-incubation of intact-rings with VK{sub 1} reduced both acetylcholine- and bradykinin-induced relaxation. VK{sub 1}more » induced an increment in tension on carotid rings submaximally pre-contracted with phenylephrine. VK{sub 1}-induced increment in tension was completely abolished by endothelial removal or incubation of intact rings with L-NAME and L-NNA. Conversely, 7-nitroindazole, 1400 W, or indomethacin did not affect VK{sub 1}-induced contraction. Moreover, VK{sub 1} reduced L-arginine-induced relaxation in endothelium-intact rings. Lucigenin-amplified chemiluminescence assays showed that VK{sub 1} induced an increase in the level of superoxide anions in endothelium-intact but not denuded rings. Measurement of nitrite and nitrate generation showed that VK{sub 1} did not alter nitrate formation but strongly inhibited the generation of nitrite. Finally, the superoxide anions scavenger tiron prevented the endothelial vasomotor dysfunction caused by VK{sub 1} on phenyleprine-induced contraction and acetylcholine or bradykinin-induced relaxation. In conclusion, our data show that VK{sub 1} disrupts the vasomotor function of rat carotid. Our results suggest that VK{sub 1}-induced oxidative stress through production of superoxide anion is interfering with the NO pathway, which in turn is responsible for the altered vascular reactivity induced by VK{sub 1}.« less

Decrease of Perivascular Adipose Tissue Browning Is Associated With Vascular Dysfunction in Spontaneous Hypertensive Rats During Aging.

PubMed

Kong, Ling-Ran; Zhou, Yan-Ping; Chen, Dong-Rui; Ruan, Cheng-Chao; Gao, Ping-Jin

2018-01-01

Functional perivascular adipose tissue (PVAT) is necessary to maintain vascular physiology through both mechanical support and endocrine or paracrine ways. PVAT shows a brown adipose tissue (BAT)-like feature and the browning level of PVAT is dependent on the anatomic location and species. However, it is not clear whether PVAT browning is involved in the vascular tone regulation in spontaneously hypertensive rats (SHRs). In the present study, we aimed to illustrate the effect of aging on PVAT browning and subsequent vasomotor reaction in SHRs. Herein we utilized histological staining and western blot to detect the characteristics of thoracic PVAT (tPVAT) in 8-week-old and 16-week-old SHR and Wistar-Kyoto (WKY) rats. We also detected vascular reactivity analysis to determine the effect of tPVAT on vasomotor reaction during aging. The results showed that tPVAT had a similar phenotype to BAT, including smaller adipocyte size and positive uncoupling protein-1 (UCP1) staining. Interestingly, the tPVAT of 8-week-old SHR showed increased BAT phenotypic marker expression compared to WKY, whereas the browning level of tPVAT had a more dramatic decrease from 8 to 16 weeks of age in SHR than age-matched WKY rats. The vasodilation effect of tPVAT on aortas had no significant difference in 8-week-old WKY and SHR, whereas this effect is obviously decreased in 16-week-old SHR compared to WKY. In contrast, tPVAT showed a similar vasoconstriction effect in 8- or 16-week-old WKY and SHR rats. Moreover, we identified an important vasodilator adenosine, which regulates adipocyte browning and may be a potential PVAT-derived relaxing factor. Adenosine is dramatically decreased from 8 to 16 weeks of age in the tPVAT of SHR. In summary, aging is associated with a decrease of tPVAT browning and adenosine production in SHR rats. These may result in attenuated vasodilation effect of the tPVAT in SHR during aging.

Fos and FRA protein expression in rat nucleus paragigantocellularis lateralis during different space flight conditions.

PubMed

d'Ascanio, Paola; Centini, Claudia; Pompeiano, Maria; Pompeiano, Ottavio; Balaban, Evan

2002-10-15

The nucleus paragigantocellularis lateralis (LPGi) exerts a prominent excitatory influence over locus coeruleus (LC) neurons, which respond to gravity signals. We investigated whether adult albino rats exposed to different gravitational fields during the NASA Neurolab Mission (STS-90) showed changes in Fos and Fos-related antigen (FRA) protein expression in the LPGi and related cardiovascular, vasomotor, and respiratory areas. Fos and FRA proteins are induced rapidly by external stimuli and return to basal levels within hours (Fos) or days (FRA) after stimulation. Exposure to a light pulse (LP) 1 h prior to sacrifice led to increased Fos expression in subjects maintained for 2 weeks in constant gravity (either at approximately 0 or 1 G). Within 24 h of a gravitational change (launch or landing), the Fos response to LP was abolished. A significant Fos response was also induced by gravitational stimuli during landing, but not during launch. FRA responses to LP showed a mirror image pattern, with significant responses 24 h after launch and landing, but no responses after 2 weeks at approximately 0 or 1 G. There were no direct FRA responses to gravity changes. The juxtafacial and retrofacial parts of the LPGi, which integrate somatosensory/acoustic and autonomic signals, respectively, also showed gravity-related increases in LP-induced FRA expression 24 h after launch and landing. The neighboring nucleus ambiguus (Amb) showed completely different patterns of Fos and FRA expression, demonstrating the anatomical specificity of these results. Immediate early gene expression in the LPGi and related cardiovascular vasomotor and ventral respiratory areas may be directly regulated by excitatory afferents from vestibular gravity receptors. These structures could play an important role in shaping cardiovascular and respiratory function during adaptation to altered gravitational environments encountered during space flight and after return to earth. Copyright 2002 Elsevier Science Inc.

Genetic testing for hereditary cancer predisposition: BRCA1/2, Lynch syndrome, and beyond.

PubMed

Hall, M J; Obeid, E I; Schwartz, S C; Mantia-Smaldone, G; Forman, A D; Daly, M B

2016-03-01

Obstetrician/gynecologists and gynecologic oncologists serve an integral role in the care of women at increased hereditary risk of cancer. Their contribution includes initial identification of high risk patients, screening procedures like bimanual exam, trans-vaginal ultrasound and endometrial biopsy, prophylaxis via TAH and/or BSO, and chemoprevention. Further, gynecologists also serve a central role in the management of the secondary repercussions of efforts to mitigate increased cancer risks, including vasomotor symptoms, sexual function, bone health, cardiovascular disease, and mental health. The past several years has seen multiple new high and moderate penetrance genes introduced into the clinical care of women at increased risk of gynecologic malignancy. Awareness of these new genes and the availability of new multi-gene panel tests is critical for providers on the front-line of women's health. Copyright © 2016 Elsevier Inc. All rights reserved.

Magnesium in Prevention and Therapy

PubMed Central

Gröber, Uwe; Schmidt, Joachim; Kisters, Klaus

2015-01-01

Magnesium is the fourth most abundant mineral in the body. It has been recognized as a cofactor for more than 300 enzymatic reactions, where it is crucial for adenosine triphosphate (ATP) metabolism. Magnesium is required for DNA and RNA synthesis, reproduction, and protein synthesis. Moreover, magnesium is essential for the regulation of muscular contraction, blood pressure, insulin metabolism, cardiac excitability, vasomotor tone, nerve transmission and neuromuscular conduction. Imbalances in magnesium status—primarily hypomagnesemia as it is seen more common than hypermagnesemia—might result in unwanted neuromuscular, cardiac or nervous disorders. Based on magnesium’s many functions within the human body, it plays an important role in prevention and treatment of many diseases. Low levels of magnesium have been associated with a number of chronic diseases, such as Alzheimer’s disease, insulin resistance and type-2 diabetes mellitus, hypertension, cardiovascular disease (e.g., stroke), migraine headaches, and attention deficit hyperactivity disorder (ADHD). PMID:26404370

Quality of life among menopausal women: A community-based study in a rural area of West Bengal.

PubMed

Karmakar, Nabarun; Majumdar, Somak; Dasgupta, Aparajita; Das, Sulagna

2017-01-01

During menopausal transition, there is a lot of fluctuation in the hormone levels making the peri and postmenopausal women susceptible to various mental and physical disorders. There is considerably lack of awareness about the effects of the menopausal symptoms in women in India. Studies on issues relating to menopause, especially among rural women, are also lacking. With this background, the current study was carried out in a rural area of West Bengal with the objective to assess the quality of life (QOL) of peri-menopausal women. The study was carried out among 100 peri and postmenopausal women (40-60 years) in Dearah village of West Bengal which is the rural field practice area of All India Institute of Hygiene and Public Health during February-March 2014. The questionnaire used as study tool had two parts - Part 1: Sociodemographic characteristics. Part 2: About QOL due to menopausal symptoms based on four domains (vasomotor, psychosocial, physical, and sexual) using the 29-item Menopause-Specific Quality of Life Questionnaire. Occurrence of vasomotor symptoms was average with 60% of them reporting hot flushes and 47% sweating. Most prevalent psychosocial symptoms reported were feeling of anxiety and nervousness (94%) and overall depression (88%). Physical symptoms were quite varying in occurrence with some symptoms such as feeling tired or worn out, decrease in physical strength and lack of energy occurring in 93% of the women to only 5% suffering from growth of facial hair. Overall sexual changes were reported among 49% who reported of avoiding intimacy with a partner and 26% complained of vaginal dryness. The results support that menopause causes both physical and psychiatric problems. Education, creating awareness and providing suitable intervention to improve their QOL are important which should be imparted to menopausal women at both individual and community level.

Burden of vasomotor symptoms in France, Germany, Italy, Spain, and the United Kingdom.

PubMed

Dibonaventura, Marco Dacosta; Chandran, Arthi; Hsu, Ming-Ann; Bushmakin, Andrew

2013-01-01

Several studies have documented a significant association between vasomotor symptoms (VMS) and a decrement in health outcomes among postmenopausal women, but these studies have mostly focused on the US. The aim of the current study was to broaden this investigation by examining the burden of VMS symptoms in the European Union with respect to both humanistic and economic outcomes. All women aged 40-75 years who completed the 2010 5EU (France, Germany, Italy, Spain, and the UK) National Health and Wellness Survey were identified as potential respondents and invited to participate in an additional cross-sectional, Internet-based survey. Only postmenopausal women from 5EU were included in the current analyses (n = 3801). VMS was assessed using the Menopausal Rating Scale, and was used in multiple regression models as the primary predictor of health status (EQ-5D-3L), work productivity loss, and the number of physician visits due to menopause. Over half (50.3%) of postmenopausal women experienced either mild (24.6%), moderate (17.6%), or severe (8.1%) VMS. Controlling for confounding variables, mild (b = -0.03, P < 0.05), moderate (b = -0.07, P < 0.05), and severe VMS (b = -0.17, P < 0.05) were each associated with worse health utilities relative to women without VMS. Similarly, increased resource use (b = 1.04-2.39, all P < 0.05), overall work impairment (b = 8.71-19.69, all P < 0.05), and activity impairment (b = 11.22-24.54, all P < 0.05) were also observed as VMS severity increased (with each b representing the difference between each level of severity and the reference category). These results suggest a high prevalence of VMS in Western Europe. These symptoms are also associated with both humanistic and economic outcomes. Improved management of VMS may be able to increase the health status and ability to work productively as well as reduce societal direct costs.

Effects of oral versus transdermal menopausal hormone treatments on self-reported sleep domains and their association with vasomotor symptoms in recently menopausal women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS).

PubMed

Cintron, Dahima; Lahr, Brian D; Bailey, Kent R; Santoro, Nanette; Lloyd, Robin; Manson, JoAnn E; Neal-Perry, Genevieve; Pal, Lubna; Taylor, Hugh S; Wharton, Whitney; Naftolin, Fredrick; Harman, S Mitchell; Miller, Virginia M

2018-02-01

This study determined whether two different formulations of hormone therapy (HT): oral conjugated equine estrogens (o-CEE; 0.45 mg/d, n = 209), transdermal 17β-estradiol (t-E2; 50 μg/d, n = 201) plus cyclic progesterone (Prometrium, 200 mg) or placebo (PBO, n = 243) affected sleep domains in participants of the Kronos Early Estrogen Prevention Study. Participants completed the Pittsburgh Sleep Quality Index at baseline and during the intervention at 6, 18, 36, and 48 months. Global sleep quality and individual sleep domain scores were compared between treatments using analysis of covariance, and correlated with vasomotor symptom (VMS) scores using Spearman correlation coefficients. Global Pittsburgh Sleep Quality Index scores (mean 6.3; 24% with score >8) were similar across groups at baseline and were reduced (improved sleep quality) by both HT (average change -1.27 [o-CEE] and -1.32 [t-E2]) when compared with PBO (-0.60; P = 0.001 [o-CEE vs PBO] and P = 0.002 [t-E2 vs PBO]). Domain scores for sleep satisfaction and latency improved with both HT. The domain score for sleep disturbances improved more with t-E2 than o-CEE or PBO. Global sleep scores significantly correlated with VMS severity (rs = 0.170, P < 0.001 for hot flashes; rs = 0.177, P < 0.001 for night sweats). Change in scores for all domains except sleep latency and sleep efficiency correlated with change in severity of VMS. Poor sleep quality is common in recently menopausal women. Sleep quality improved with both HT formulations. The relationship of VMS with domains of sleep suggests that assessing severity of symptoms and domains of sleep may help direct therapy to improve sleep for postmenopausal women.

Effects of oral versus transdermal menopausal hormone treatments on self-reported sleep domains and their association with vasomotor symptoms in recently menopausal women enrolled in the Kronos Early Estrogen Prevention Study (KEEPS)

PubMed Central

Cintron, Dahima; Lahr, Brian D.; Bailey, Kent R.; Santoro, Nanette; Lloyd, Robin; Manson, JoAnn E.; Neal-Perry, Genevieve; Pal, Lubna; Taylor, Hugh S.; Wharton, Whitney; Naftolin, Fredrick; Harman, S. Mitchell; Miller, Virginia M.

2018-01-01

Abstract Objective: This study determined whether two different formulations of hormone therapy (HT): oral conjugated equine estrogens (o-CEE; 0.45 mg/d, n = 209), transdermal 17β-estradiol (t-E2; 50 μg/d, n = 201) plus cyclic progesterone (Prometrium, 200 mg) or placebo (PBO, n = 243) affected sleep domains in participants of the Kronos Early Estrogen Prevention Study. Methods: Participants completed the Pittsburgh Sleep Quality Index at baseline and during the intervention at 6, 18, 36, and 48 months. Global sleep quality and individual sleep domain scores were compared between treatments using analysis of covariance, and correlated with vasomotor symptom (VMS) scores using Spearman correlation coefficients. Results: Global Pittsburgh Sleep Quality Index scores (mean 6.3; 24% with score >8) were similar across groups at baseline and were reduced (improved sleep quality) by both HT (average change −1.27 [o-CEE] and −1.32 [t-E2]) when compared with PBO (−0.60; P = 0.001 [o-CEE vs PBO] and P = 0.002 [t-E2 vs PBO]). Domain scores for sleep satisfaction and latency improved with both HT. The domain score for sleep disturbances improved more with t-E2 than o-CEE or PBO. Global sleep scores significantly correlated with VMS severity (rs = 0.170, P < 0.001 for hot flashes; rs = 0.177, P < 0.001 for night sweats). Change in scores for all domains except sleep latency and sleep efficiency correlated with change in severity of VMS. Conclusions: Poor sleep quality is common in recently menopausal women. Sleep quality improved with both HT formulations. The relationship of VMS with domains of sleep suggests that assessing severity of symptoms and domains of sleep may help direct therapy to improve sleep for postmenopausal women. PMID:28832429

Beer Polyphenols and Menopause: Effects and Mechanisms—A Review of Current Knowledge

PubMed Central

Sandoval-Ramírez, Berner Andrée; M. Lamuela-Raventós, Rosa; Estruch, Ramon; Sasot, Gemma; Doménech, Monica

2017-01-01

Beer is one of the most frequently consumed fermented beverages in the world, and it has been part of the human diet for thousands of years. Scientific evidence obtained from the development of new techniques of food analysis over the last two decades suggests that polyphenol intake derived from moderate beer consumption may play a positive role in different health outcomes including osteoporosis and cardiovascular risk and the relief of vasomotor symptoms, which are commonly experienced during menopause and are an important reason why women seek medical care during this period; here, we review the current knowledge regarding moderate beer consumption and its possible effects on menopausal symptoms. The effect of polyphenol intake on vasomotor symptoms in menopause may be driven by the direct interaction of the phenolic compounds present in beer, such as 8-prenylnaringenin, 6-prenylnaringenin, and isoxanthohumol, with intracellular estrogen receptors that leads to the modulation of gene expression, increase in sex hormone plasma concentrations, and thus modulation of physiological hormone imbalance in menopausal women. Since traditional hormone replacement therapies increase health risks, alternative, safer treatment options are needed to alleviate menopausal symptoms in women. The present work aims to review the current data on this subject. PMID:28904736

Vasomotor symptoms: viewpoint from the Indian subcontinent and management of a common menopausal problem.

PubMed

Shah, Duru; Agrawal, Sangeeta

2010-09-01

Vasomotor symptoms (VMS) are recognized to adversely affect the quality of life. The prevalence and the magnitude of VMS may vary across populations. Although a natural regression of VMS may be expected over a period of time, it remains the most common of symptoms for which women seek help. Menopausal hormone therapy (MHT) is currently the only treatment approved by the Food and Drug Administration that has shown uniform benefit in the management of VMS. In clinical situations when estrogen is or may be contraindicated, a finite number of alternative options, including use of neuroactive agents (SSRIs, SSNRs, and gabapentin), lifestyle changes, and nonprescription remedies such as phytoestrogens and black cohosh have been shown to provide relief, albeit with mixed results and questionable safety. Existing data identify an ethnic variation in the degree and frequency of VMS of aging; in this latter context, the Asian woman's perspective is dominantly conveyed from the perspective of Chinese and Japanese ethnicities, whereas data regarding the magnitude of burden of VMS in the postmenopausal women from other Asian ethnicities and races are sparse. This article reviews the symptoms and relates that VMS are of significant concern for the aging Asian women. © Thieme Medical Publishers.

Differential roles of NADPH oxidases in vascular physiology and pathophysiology

PubMed Central

Amanso, Angelica M.; Griendling, Kathy K.

2012-01-01

Reactive oxygen species (ROS) are produced by all vascular cells and regulate the major physiological functions of the vasculature. Production and removal of ROS are tightly controlled and occur in discrete subcellular locations, allowing for specific, compartmentalized signaling. Among the many sources of ROS in the vessel wall, NADPH oxidases are implicated in physiological functions such as control of vasomotor tone, regulation of extracellular matrix and phenotypic modulation of vascular smooth muscle cells. They are involved in the response to injury, whether as an oxygen sensor during hypoxia, as a regulator of protein processing, as an angiogenic stimulus, or as a mechanism of wound healing. These enzymes have also been linked to processes leading to disease development, including migration, proliferation, hypertrophy, apoptosis and autophagy. As a result, NADPH oxidases participate in atherogenesis, systemic and pulmonary hypertension and diabetic vascular disease. The role of ROS in each of these processes and diseases is complex, and a more full understanding of the sources, targets, cell-specific responses and counterbalancing mechanisms is critical for the rational development of future therapeutics. PMID:22202108

Mild elevation of body temperature reduces tumor interstitial fluid pressure and hypoxia and enhances efficacy of radiotherapy in murine tumor models.

PubMed

Sen, Arindam; Capitano, Maegan L; Spernyak, Joseph A; Schueckler, John T; Thomas, Seneca; Singh, Anurag K; Evans, Sharon S; Hylander, Bonnie L; Repasky, Elizabeth A

2011-06-01

Human and rodent solid tumors often exhibit elevated interstitial fluid pressure (IFP). This condition is recognized as a prognostic indicator for reduced responses to therapy and decreased disease-free survival rate. In the present study, we tested whether induction of a thermoregulatory-mediated increase in tissue blood flow, induced by exposure of mice to mild environmental heat stress, could influence IFP and other vascular parameters within tumors. Using several murine tumor models, we found that heating results in a sustained reduction in tumor IFP correlating with increased tumor vascular perfusion (measured by fluorescent imaging of perfused vessels, laser Doppler flowmetry, and MRI) as well as a sustained reduction in tumor hypoxia. Furthermore, when radiation therapy was administered 24 hours postheating, we observed a significant improvement in efficacy that may be a result of the sustained reduction in tumor hypoxia. These data suggest, for the first time, that environmental manipulation of normal vasomotor function is capable of achieving therapeutically beneficial changes in IFP and microvascular function in the tumor microenvironment.

Physiological responses induced by pleasant stimuli.

PubMed

Watanuki, Shigeki; Kim, Yeon-Kyu

2005-01-01

The specific physiological responses induced by pleasant stimuli were investigated in this study. Various physiological responses of the brain (encephaloelectrogram; EEG), autonomic nervous system (ANS), immune system and endocrine system were monitored when pleasant stimuli such as odors, emotional pictures and rakugo, a typical Japanese comical story-telling, were presented to subjects. The results revealed that (i) EEG activities of the left frontal brain region were enhanced by a pleasant odor; (ii) emotional pictures related to primitive element such as nudes and erotic couples elevated vasomotor sympathetic nervous activity; and (iii) an increase in secretory immunoglobulin A (s-IgA) and a decrease in salivary cortisol (s-cortisol) were induced by rakugo-derived linguistic pleasant emotion. Pleasant emotion is complicated state. However, by considering the evolutionary history of human being, it is possible to assess and evaluate pleasant emotion from certain physiological responses by appropriately summating various physiological parameters.

Effect of ascorbic acid on endothelial dysfunction of epicardial coronary arteries in chronic smokers assessed by cold pressor testing.

PubMed

Schindler, T H; Magosaki, N; Jeserich, M; Olschewski, M; Nitzsche, E; Holubarsch, C; Solzbach, U; Just, H

2000-01-01

In chronic smokers there is evidence for increased formation of oxygen-derived free radicals within the vessel wall impairing endothelial function. It has been suggested that the inactivation of endothelium-derived nitric oxide by oxygen free radicals contributes to endothelial dysfunction. Hence, we tested the hypothesis that in chronic smokers the antioxidant ascorbic acid could improve abnormal endothelial function of epicardial coronary arteries. Thirty-one patients (mean age 57 +/- 9 years) referred for routine diagnostic catheterization for evaluation of chest pain and without angiographically significant coronary artery stenoses were randomly assigned to one of the study groups to assess vasomotor response of epicardial coronary arteries due to cold pressor testing (CPT) before and after intravenous infusion of 3 g of ascorbic acid or 100 ml x 0.9% saline infusion. In 6 controls (mean age 55 +/- 3 years) CPT led to a similar increase in luminal area before and after ascorbic acid administration (26.5 +/- 15.0 vs. 28.4 +/- 17.7%, p = NS). In 15 chronic smokers (mean age 55 +/- 9 years), CPT induced a decrease in the luminal area of -18.5 +/- 6.3%. This flow-dependent vasoconstriction was significantly reversed to 7.7 +/- 6.2% (p < or = 0.03) vasodilation after intravenous ascorbic acid administration. In 10 chronic smokers (mean age 57 +/- 11 years) saline infusion (placebo) did not have a significant effect on CPT-induced vasoconstriction (-12.7 +/- 5.1 vs. -13.1 +/- 5.1%, p = NS). The CPT-induced increase in luminal area in chronic smokers after ascorbic acid infusion was significant compared to controls and placebo (each p < or = 0.05). Our assessment of endothelium-independent responses to nitroglycerin revealed no significant differences between the single study groups (p = NS). In chronic smokers acute intravenous administration of ascorbic acid significantly improves CPT-induced coronary endothelium-dependent dysfunction. According to the current understanding, this effect is due to improved cellular redox imbalance and prevention of nitric oxide inactivation in the endothelium and subendothelial space.

Current recommendations: what is the clinician to do?

PubMed

Manson, Joann E

2014-04-01

Menopausal hormone therapy (HT) has complex biologic effects but continues to have an important clinical role in the management of vasomotor and other menopausal symptoms. The rational use of menopausal HT requires balancing the potential benefits and risks of treatment. Findings from the Women's Health Initiative (WHI) and other randomized clinical trials have helped to clarify the benefits and risks of HT and have provided insights to improve decision making. Several clinical characteristics have utility in identifying women for whom benefits of HT are likely to outweigh the risks. Age and time since menopause are strong predictors of health outcomes and absolute risks associated with HT, and differences by age have been particularly apparent for estrogen alone. In the WHI trial of conjugated equine estrogens (CEE) alone, younger women (50-59 years) had more favorable results for all-cause mortality, myocardial infarction, and the global index, but not for stroke and venous thrombosis. Age trends were less clear for CEE + medroxyprogesterone acetate, owing to increased risks of breast cancer, stroke, and venous thrombosis in all age groups. Absolute risks of adverse events were lower in younger than in older women in both trials, however. Other predictors of lower vascular risk from HT include favorable lipid status and absence of the metabolic syndrome. Transdermal administration may be associated with lower risks of venous thrombosis and stroke, but additional research is needed. The use of risk stratification and personalized risk assessment offers promise for improved benefit-risk profile and safety of HT. One approach to decision making is presented. Key elements include: assessment of whether the patient has moderate to severe menopausal symptoms, the primary indication for initiating systemic HT (vaginal estrogen may be used to treat genitourinary symptoms in the absence of vasomotor symptoms); understanding the patient's own preference regarding therapy; evaluating the patient for the presence of any contraindications to HT, as well as the time since menopause onset and baseline risks of cardiovascular disease and breast cancer; reviewing carefully the benefits and risks of treatment with the patient, giving more emphasis to absolute than to relative measures of effect; and, if HT is initiated, regularly reviewing the patient's need for continued treatment. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systematic review of randomised controlled trials.

PubMed

Teleni, Laisa; Chan, Raymond J; Chan, Alexandre; Isenring, Elisabeth A; Vela, Ian; Inder, Warrick J; McCarthy, Alexandra L

2016-02-01

Men receiving androgen deprivation therapy (ADT) for prostate cancer (PCa) are likely to develop metabolic conditions such as diabetes, cardiovascular disease, abdominal obesity and osteoporosis. Other treatment-related side effects adversely influence quality of life (QoL) including vasomotor distress, depression, anxiety, mood swings, poor sleep quality and compromised sexual function. The objective of this study was to systematically review the nature and effects of dietary and exercise interventions on QoL, androgen deprivation symptoms and metabolic risk factors in men with PCa undergoing ADT. An electronic search of CINAHL, CENTRAL, Medline, PsychINFO and reference lists was performed to identify peer-reviewed articles published between January 2004 and December 2014 in English. Eligible study designs included randomised controlled trials (RCTs) with pre- and post-intervention data. Data extraction and assessment of methodological quality with the Cochrane approach was conducted by two independent reviewers. Seven exercise studies were identified. Exercise significantly improved QoL, but showed no effect on metabolic risk factors (weight, waist circumference, lean or fat mass, blood pressure and lipid profile). Two dietary studies were identified, both of which tested soy supplements. Soy supplementation did not improve any outcomes. No dietary counselling studies were identified. No studies evaluated androgen-deficiency symptoms (libido, erectile function, sleep quality, mood swings, depression, anxiety and bone mineral density). Evidence from RCTs indicates that exercise enhances health- and disease-specific QoL in men with PCa undergoing ADT. Further studies are required to evaluate the effect of exercise and dietary interventions on QoL, androgen deprivation symptoms and metabolic risk factors in this cohort. © 2016 Society for Endocrinology.

Hydralazine administration activates sympathetic preganglionic neurons whose activity mobilizes glucose and increases cardiovascular function.

PubMed

Parker, Lindsay M; Damanhuri, Hanafi A; Fletcher, Sophie P S; Goodchild, Ann K

2015-04-16

Hypotensive drugs have been used to identify central neurons that mediate compensatory baroreceptor reflex responses. Such drugs also increase blood glucose. Our aim was to identify the neurochemical phenotypes of sympathetic preganglionic neurons (SPN) and adrenal chromaffin cells activated following hydralazine (HDZ; 10mg/kg) administration in rats, and utilize this and SPN target organ destination to ascribe their function as cardiovascular or glucose regulating. Blood glucose was measured and adrenal chromaffin cell activation was assessed using c-Fos immunoreactivity (-ir) and phosphorylation of tyrosine hydroxylase, respectively. The activation and neurochemical phenotype of SPN innervating the adrenal glands and celiac ganglia were determined using the retrograde tracer cholera toxin B subunit, in combination with in situ hybridization and immunohistochemistry. Blood glucose was elevated at multiple time points following HDZ administration but little evidence of chromaffin cell activation was seen suggesting non-adrenal mechanisms contribute to the sustained hyperglycemia. 16±0.1% of T4-T11 SPN contained c-Fos and of these: 24.3±1.4% projected to adrenal glands and 29±5.5% projected to celiac ganglia with the rest innervating other targets. 62.8±1.4% of SPN innervating adrenal glands were activated and 29.9±3.3% expressed PPE mRNA whereas 53.2±8.6% of SPN innervating celiac ganglia were activated and 31.2±8.8% expressed PPE mRNA. CART-ir SPN innervating each target were also activated and did not co-express PPE mRNA. Neurochemical coding reveals that HDZ administration activates both PPE+SPN, whose activity increase glucose mobilization causing hyperglycemia, as well as CART+SPN whose activity drive vasomotor responses mediated by baroreceptor unloading to raise vascular tone and heart rate. Copyright © 2015 Elsevier B.V. All rights reserved.

Beat-to-beat blood pressure analysis after premature ventricular contraction indicates sensitive baroreceptor dysfunction in Parkinson's disease.

PubMed

Haensch, Carl-Albrecht; Jörg, Johannes

2006-04-01

Extrasystoles occur in normal subjects but are significant more frequently (16.25% vs. 55%; chi(2) = 19.3; P < 0.001) seen in Parkinson's disease (PD) patients. The extrasystolic decreases in stroke volume and systolic pressure activate sympathetic vasomotor innervation and lead to a blood pressure increase for a few heartbeats. The purpose of this study was to prove whether the short time analysis of this blood pressure regulation allows the assessment of sympathetic neurocirculatory function. Records of noninvasive blood pressure monitoring were reviewed from 40 PD patients and 80 controls. A battery of cardiovascular autonomic tests, including Valsalva maneuver, tilt-table testing, echocardiography, and cardiac scintigraphy with [(123)I]meta-iodobenzylguanidine were performed. Fifty-five percent of the PD patients had at least one premature ventricular contraction (PVC) in 10 minutes lying supine at rest. After every PVC (13 PVCs) recorded from normal subjects, we found an increase in systolic blood pressure above base line with a maximum at the seventh heart beat. In all of the 22 PD patients, the systolic blood pressure was significantly decreased less than baseline in every PVC from the second to the ninth postextrasystolic beat (P < 0.001). In both groups, the extrasystolic fall in blood pressure was on average approximately 22%. The postextrasystolic potentiation did not differ (5.3% vs. 4.4%, not significant). If a PVC occurs, the analysis of short-time blood pressure regulation is a sensitive tool for baroreceptor reflex function. The advantage of this method results from the independence of patients cooperation and the high sensitivity to prove a sympathetic neurocirculatory failure within 10 heart beats. Copyright 2005 Movement Disorder Society.

Use of mindfulness, meditation and relaxation to treat vasomotor symptoms.

PubMed

Goldstein, K M; Shepherd-Banigan, M; Coeytaux, R R; McDuffie, J R; Adam, S; Befus, D; Goode, A P; Kosinski, A S; Masilamani, V; Williams, J W

2017-04-01

Postmenopausal women with bothersome vasomotor symptoms (VMS) often seek alternatives to hormone-based treatment due to medication risks or personal preference. We sought to identify the effects of meditation, mindfulness, hypnosis and relaxation on VMS and health-related quality of life in perimenopausal and postmenopausal women. To do this, we conducted an umbrella review supplemented by new randomized, controlled trials (RCTs) published since the most recent good-quality systematic review for eligible interventions. We searched MEDLINE and the Cochrane Database of Systematic Reviews, PubMed, EMBASE, CINAHL and the Allied and Complementary Medicine Databases. We identified five systematic reviews and six new RCTs that met eligibility criteria. In a new meta-analysis examining four RCTs comparing paced respiration with a control group, we found that paced respiration is not associated with a statistically significant decrease in VMS frequency (standardized mean difference (SMD) 0.04, 95% confidence interval (CI) -0.73 to 0.82, I 2  =   56.6%, three trials) or severity (SMD 0.06, 95% CI -0.69 to 0.80; I 2  =   65.1%, three trials). There was not sufficient new information to conduct meta-analyses that examined the effect of mindfulness or hypnosis on our outcomes of interest. No effect on VMS or quality of life was found between various relaxation or mindfulness interventions.

The influence of body fat distribution patterns and body mass index on MENQOL in women living in an urban area.

PubMed

Kutheerawong, L; Vichinsartvichai, P

2016-01-01

To investigate the influence of patterns of body fat distribution and body mass index (BMI) on menopause-specific quality of life in peri- and postmenopausal women living in an urban area. A total of 214 peri- and postmenopausal women, mean age 55 years, with intact uterus and no history of hormonal treatment were recruited. Anthropometric measurements were conducted as standard techniques. The Menopause-specific Quality of Life (MENQOL) questionnaire was used to evaluate menopause-specific quality of life. The Mann-Whitney U test and Kruskal-Wallis test were used to compare MENQOL between body fat patterns or BMI. According to the body fat distribution patterns, 53.3% were women of the android type and 46.7% were of the gynoid type. The android body pattern was associated with worsening of vasomotor and psychosocial domains (p < 0.05). However, overweight and obese women had slightly better scores in the sexual domain of the MENQOL. Peri- and postmenopausal women with the android body pattern have lower quality of life in the vasomotor and psychosocial domains while women with normal BMI have the slightly lower quality of life in the sexual domain. The maintenance of premenopausal body proportion might mitigate the menopause-specific quality of life.

Efficacy of Cimicifuga racemosa, Hypericum perforatum and Agnus castus in the treatment of climacteric complaints: a systematic review.

PubMed

Laakmann, Elena; Grajecki, Donata; Doege, Katja; zu Eulenburg, Christine; Buhling, Kai J

2012-09-01

The systematic review examines whether Cimicifuga racemosa (CR), Hypericum perforatum (HP), Agnus castus, vitamins and minerals, either as monotherapy or in combination, have an evidence-based impact on vasomotor, genital and psychological climacteric complaints. DATA SOURCES AND METHODS OF STUDY SELECTION: We searched in the databases EMBASE, OVID and PubMed using the keywords "vasomotor symptoms, hot flashes, vaginal atrophy, psychological problems, endometrium, sleep, concentration, cognition in combination with vitamins, multivitamins, minerals, multiminerals, black cohosh, Cimicifuga, Agnus castus, chasteberry, chaste tree, monk's pepper and menopause" for randomized controlled trials (RCT). Relevant studies were reviewed by four independent reviewers qualitatively. Most of the studies with a comparison of CR vs. placebo do not show an evidence-based significant effect of CR on climacteric symptoms. The combination of CR and HP shows an improvement of climacteric complaints in comparison to placebo. In some RCTs, there was no significant difference between CR and hormone-replacement therapy. The combination of HP and Agnus castus showed no significant difference in the treatment of climacteric complaints. CR monotherapy as well as HP and Agnus castus showed no better effect than placebo. The combination of CR with HP demonstrated a positive effect on climacteric complaints.

Circulatory response and autonomic nervous activity during gum chewing.

PubMed

Hasegawa, Yoko; Sakagami, Joe; Ono, Takahiro; Hori, Kazuhiro; Zhang, Min; Maeda, Yoshinobu

2009-08-01

Mastication has been proven to enhance the systemic circulation, with circulatory responses seeming to be largely regulated by autonomic nervous activity via a more complex regulatory system than those of other activities. However, few studies have examined the relationships between changes in autonomic nervous activity and the systemic circulation that are induced by masticatory movement. We investigated changes in the systemic circulation and autonomic nervous activity during gum chewing to clarify the influence of mastication. Electrocardiograms, arterial blood pressure, and masseter electromyograms were taken while chewing gum continuously as indicators of systemic circulation in 10 healthy subjects with normal dentition. Cardiac sympathetic activity and vagus nervous activity, as well as vasomotor sympathetic nervous activity, were evaluated by fluctuation analysis of heart rate and blood pressure. Repeated analysis of variance and multiple comparisons were performed to determine chronological changes in each indicator during gum chewing. Gum chewing increased the heart rate and the mean arterial pressure. Although cardiac sympathetic activity and vagus nervous activity showed significant changes, vasomotor sympathetic nervous activity did not. These results suggest that changes in the autonomic nervous activity of the heart are mainly involved in the enhancement of systemic circulation with gum chewing. This explains some characteristics of autonomic nervous regulation in masticatory movement.

[Efferent innervation of the arteries of human leptomeninx in arterial hypertension].

PubMed

Chertok, V M; Kotsiuba, A E; Babich, E V

2009-01-01

Structure of the efferent nerve plexuses (adrenergic, acetylcholinestherase- and cholinacetyltranspherase-positive, NO-dependent), was studied in the arteries of human leptomeninx with different diameters. Material was obtained from the corpses of the healthy people and of the patients with initial stages of arterial hypertension (AH). It was shown that the concentrations of cholinergic and adrenergic nerve fibers and varicosities in axon terminal part, innervating the arteries with the diameters ranging from 450 till 100 microm, were not significantly different. In these arteries, NO-ergic plexuses were also detected. In patients with AH, regardless the arterial diameters, the significant increase (up to 15-20%) of adrenergic nerve fiber and varicosity concentrations was found. The changes in cholinergic nerve fiber concentration were found to depend on the vessel diameter: the significant decrease of these parameter was observed only in arteries with the diameter of 100-200 microm. No significant changes in nerve plexus concentration was noticed in the arteries with greater or smaller diameter. In NO-ergic neural conductors, the enzyme activity decreased only in the large arteries, and remained almost unchanged in the small vascular branches. The changes in the vasomotor innervation described in AH, are interpreted as a vasomotor innervation dysfunction of the leptomeninx arteries that may result in the hemodynamic disturbances.

Relationship of obesity and insulin resistance with the cerebrovascular reactivity: a case control study

PubMed Central

2014-01-01

Background Obesity is associated with increased risk for stroke. The breath-holding index (BHI) is a measure of vasomotor reactivity of the brain which can be measured with the transcranial Doppler (TCD). We aim to evaluate obesity as an independent factor for altered cerebrovascular reactivity. Methods Cerebrovascular hemodynamics (mean flow velocities MFV, pulsatility index, PI, resistance index, RI, and BHI) was determined in 85 non-obese (Body Mass Index, BMI ≤27 kg/m2) and 85 obese subjects (BMI ≥35 kg/m2) without diabetes mellitus and hypertension. Anthropometric and metabolic variables, and scores to detect risk for obstructive sleep apnea (OSA) were analyzed for their association with the cerebrovascular reactivity. Results The BHI was significantly lower in subjects with obesity according to BMI and in subjects with abdominal obesity, but the PI and RI were not different between groups. There was a linear association between the BMI, the HOMA-IR, the Matsuda index, the waist circumference, and the neck circumference, with the cerebrovascular reactivity. After adjusting for insulin resistance, neck circumference, and abdominal circumference, obesity according to BMI was negatively correlated with the cerebrovascular reactivity. Conclusions We found a diminished vasomotor reactivity in individuals with obesity which was not explained by the presence of insulin resistance. PMID:24383894

Functional vascular contributions to cognitive impairment and dementia: mechanisms and consequences of cerebral autoregulatory dysfunction, endothelial impairment, and neurovascular uncoupling in aging

PubMed Central

Toth, Peter; Tarantini, Stefano; Csiszar, Anna

2017-01-01

Increasing evidence from epidemiological, clinical and experimental studies indicate that age-related cerebromicrovascular dysfunction and microcirculatory damage play critical roles in the pathogenesis of many types of dementia in the elderly, including Alzheimer’s disease. Understanding and targeting the age-related pathophysiological mechanisms that underlie vascular contributions to cognitive impairment and dementia (VCID) are expected to have a major role in preserving brain health in older individuals. Maintenance of cerebral perfusion, protecting the microcirculation from high pressure-induced damage and moment-to-moment adjustment of regional oxygen and nutrient supply to changes in demand are prerequisites for the prevention of cerebral ischemia and neuronal dysfunction. This overview discusses age-related alterations in three main regulatory paradigms involved in the regulation of cerebral blood flow (CBF): cerebral autoregulation/myogenic constriction, endothelium-dependent vasomotor function, and neurovascular coupling responses responsible for functional hyperemia. The pathophysiological consequences of cerebral microvascular dysregulation in aging are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages, microvascular rarefaction, and ischemic neuronal dysfunction and damage. Due to the widespread attention that VCID has captured in recent years, the evidence for the causal role of cerebral microvascular dysregulation in cognitive decline is critically examined. PMID:27793855

Effects of ticagrelor on neointimal hyperplasia and endothelial function, compared with clopidogrel and prasugrel, in a porcine coronary stent restenosis model.

PubMed

Kim, Hyun Kuk; Jeong, Myung Ho; Lim, Kyung Seob; Kim, Jung Ha; Lim, Han Chul; Kim, Min Chul; Hong, Young Joon; Kim, Sung Soo; Park, Keun-Ho; Chang, Kyoung-Sig

2017-08-01

Several investigations have been conducted to evaluate the off-target effects of ticagrelor. The aim of the present study was to evaluate the off-target effects of ticagrelor such as neointimal formation and endothelial function after drug-eluting stent implantation in a porcine restenosis model. A total of 30 pigs were randomly allocated based on the following P2Y 12 inhibitor: (1) clopidogrel 300mg loading plus 75mg maintenance (n=10); (2) prasugrel 60mg loading plus 10mg maintenance (n=10); (3) ticagrelor 180mg loading plus 180mg maintenance (n=10). In each group, zotarolimus-eluting stents were implanted in the proximal portion of the left anterior descending artery and left circumflex artery. One month after stenting, the animals underwent follow-up angiography, endothelial function assessment, optical coherence tomography (OCT) and histopathological analysis. Regarding vasomotor responses to acetylcholine infusion, there were significant vasoconstrictions to maximal acetylcholine infusion in the clopidogrel and prasugrel group compared with those in the ticagrelor group. The mean neointimal area were significantly lower in the ticagrelor group (1.0±0.3 by OCT, 0.9±0.3 by histology), than in the clopidogrel (1.8±0.7, p=0.003, 1.6±0.8, p=0.030) and prasugrel (1.8±0.5, p=0.001, 1.5±0.5, p=0.019) groups. Percentages of moderate to dense peri-strut inflammatory cell infiltration were significantly lower in the ticagrelor group (9.0%) compared with the clopidogrel (17.3%, p<0.001) and prasugrel groups (15.7%, p=0.002). There were no significant differences in all findings between clopidogrel and prasugrel groups. Compared to clopidogrel and prasugrel, ticagrelor reduced neointimal formation, endothelial dysfunction, and peri-strut inflammation. Copyright © 2017 Elsevier B.V. All rights reserved.

Nitrergic nerves derived from the pterygopalatine ganglion innervate arteries irrigating the cerebrum but not the cerebellum and brain stem in monkeys.

PubMed

Ayajiki, Kazuhide; Kobuchi, Shuhei; Tawa, Masashi; Okamura, Tomio

2012-01-01

The functional roles of the nitrergic nerves innervating the monkey cerebral artery were evaluated in a tension-response study examining isolated arteries in vitro and cerebral angiography in vivo. Nicotine produced relaxation of arteries by stimulation of nerve terminals innervating isolated monkey arteries irrigating the cerebrum, cerebellum and brain stem. Relaxation of arteries induced by nicotine was abolished by treatment with N(G)-nitro-L-arginine, a nitric oxide synthase inhibitor, and was restored by addition of L-arginine. Cerebral angiography showed that electrical stimulation of the unilateral greater petrosal nerve, which connects to the pterygopalatine ganglion via the parasympathetic ganglion synapse, produced vasodilatation of the anterior, middle and posterior cerebral arteries in the stimulated side. However, stimulation failed to produce vasodilatation of the superior and anterior-inferior cerebellar arteries and the basilar artery in anesthetized monkeys. Therefore, nitrergic nerves derived from the pterygopalatine ganglion appear to regulate cerebral vasomotor function. In contrast, circulation in the cerebellum and brain stem might be regulated by nitrergic nerves originating not from the pterygopalatine ganglion, but rather from an unknown ganglion (or ganglia).

Zolpidem efficacy and safety in disorders of consciousness.

PubMed

Machado, Calixto; Estévez, Mario; Rodriguez-Rojas, Rafael

2018-01-01

Sutton and Clauss presented a detailed review about the effectiveness of zolpidem, discussing recoveries from brain damage due to strokes, trauma and hypoxia. A significant finding has been the unexpected and paradoxical increment of brain activity in vegetative state/unresponsive wakefulness syndrome (VS/UWS). On the contrary, zolpidem is considered one of the best sleep inducers in normal subjects. We have studied series of VS/UWS cases after zolpidem intake. We have demonstrated EEG activation, increment of BOLD signal in different brain regions, and an autonomic influence, mainly characterized by a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone. As this autonomic imbalance might induce cardio- circulatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that the paradoxical arousing zolpidem effect might be certainly related to brain function improvement, we agree with Sutton and Clauss that future multicentre and multinational clinical trials should be developed, but under control of physiological indices.

Bioimpedance harmonic analysis as a tool to simultaneously assess circulation and nervous control.

PubMed

Mudraya, I S; Revenko, S V; Nesterov, A V; Gavrilov, I Yu; Kirpatovsky, V I

2011-07-01

Multicycle harmonic (Fourier) analysis of bioimpedance was employed to simultaneously assess circulation and neural activity in visceral (rat urinary bladder) and somatic (human finger) organs. The informative value of the first cardiac harmonic of the bladder impedance as an index of bladder circulation is demonstrated. The individual reactions of normal and obstructive bladders in response to infusion cystometry were recorded. The potency of multicycle harmonic analysis of bioimpedance to assess sympathetic and parasympathetic neural control in urinary bladder is discussed. In the human finger, bioimpedance harmonic analysis revealed three periodic components at the rate of the heart beat, respiration and Mayer wave (0.1 Hz), which were observed under normal conditions and during blood flow arrest in the hand. The revealed spectrum peaks were explained by the changes in systemic blood pressure and in regional vascular tone resulting from neural vasomotor control. During normal respiration and circulation, two side cardiac peaks were revealed in a bioimpedance amplitude spectrum, whose amplitude reflected the depth of amplitude respiratory modulation of the cardiac output. During normal breathing, the peaks corresponding to the second and third cardiac harmonics were split, reflecting frequency respiratory modulation of the heart rate. Multicycle harmonic analysis of bioimpedance is a novel potent tool to examine the interaction between the respiratory and cardiovascular system and to simultaneously assess regional circulation and neural influences in visceral and somatic organs.

Platelets, neutrophils, and vasoconstriction after arterial injury by angioplasty in pigs: effects of MK-886, a leukotriene biosynthesis inhibitor

PubMed Central

Provost, Patrick; Borgeat, Pierre; Merhi, Yahye

1998-01-01

Leukotrienes constitute a class of potent bioactive mediators known to play a pivotal role in inflammation. Since their biosynthesis has been shown to be enhanced by platelet-neutrophil interactions, leukotrienes may be involved in these interactions and the arterial response to injury. Therefore, we investigated the effects of the selective leukotriene biosynthesis inhibitor 3-[1-(4-chlorobenzyl)-3-t-butyl-thio-5-isopropylindol-2-yl]-2,2-dimethylpropanoic acid (MK-886) on the acute thrombotic and vasomotor responses after arterial injury by angioplasty.Carotid arterial injury was produced by balloon dilatation in control (molecusol vehicle; n=10) and treated (MK-886, 10 mg kg−1, i.v.; n=9) pigs. The acute thrombotic reaction following deep arterial wall injury was quantified with 51Cr labelled platelets and 111In labelled neutrophils, and the vasomotor response was determined angiographically.Platelet deposition at the site of deep arterial wall injury averaged 56.4±11.0×106 platelets cm−2 in the control group, and was significantly reduced to 18.2±3.8×106 platelets cm−2 (P<0.005) by treatment with MK-886. Neutrophil deposition was also decreased by MK-886, from 242.8±36.8 to 120.9±20.3×103 neutrophils cm−2 (P<0.01). MK-886-treated animals had a significant decrease in the postangioplasty vasoconstrictive response at the site of endothelial injury distally, from 37.5±3.1% in the control group to 13.5±2.5% (P<0.001).The effects of MK-886 were associated with a profound inhibition of ex vivo leukotriene B4 (LTB4) synthesis in blood stimulated by the calcium ionophore A23187 and a significant reduction of neutrophil aggregation in whole blood (P<0.01), whereas neutrophil superoxide anion production, serum thromboxane B2 and platelet aggregation in whole blood were not influenced.The relevant effects of MK-886 are primarily related to inhibition of neutrophil function and suggest an important modulatory role for leukotrienes in the pathophysiological response associated with platelet and neutrophil interactions following arterial injury in vivo. PMID:9489613

Clinical experience with trimegestone as a new progestin in HRT.

PubMed

Grubb, Gary; Spielmann, Daniele; Pickar, James; Constantine, Ginger

2003-11-01

Trimegestone (TMG) is a novel, 19-norpregnane progestin, which demonstrates endometrial selectivity with a reduced progestin-related side effect profile when compared to several other currently marketed progestins. TMG has been studied in combination with 17beta-estradiol (17beta-E2) and conjugated equine estrogens (CEE). TMG-containing HRT agents were effective in relieving vasomotor symptoms and providing protection from endometrial hyperplasia with < or =1% hyperplasia. In clinical trials with sequential regimens, TMG provided predictable withdrawal bleeding associated with a low incidence of irregular and prolonged bleeding. Clinical studies of continuous combined regimens of estrogen/TMG combinations demonstrated high levels of amenorrhea. Both 17beta-E2 and CEE/TMG combinations have shown improved bone mineral density and quality-of-life assessments. Both continuous combined and sequential regimens of 17beta-E2/TMG and CEE/TMG have a favorable clinical profile. TMG provides an important new option for the treatment of postmenopausal symptoms and the prevention of osteoporosis.

Psychometric properties of the Chinese version of the Menopause-Specific Quality-of-Life questionnaire.

PubMed

Nie, Guangning; Yang, Hongyan; Liu, Jian; Zhao, ChunMei; Wang, Xiaoyun

2017-05-01

The Menopause-Specific Quality-of-Life (MENQOL) questionnaire was developed as a specific tool to measure the health-related quality-of-life of postmenopausal women. Thus far, the Chinese version questionnaire has not been subjected to psychometric assessment with a large sample. This study aims to evaluate the validity and reliability of the Chinese version of the MENQOL specific to postmenopausal women in China. A total of 1,137 menopausal symptomatic and 491 menopausal asymptomatic women from eight cities in China were recruited using a convenience sampling method. Psychometric properties were evaluated by descriptive statistics, validity, and reliability. Reliability was assessed for each subscale of the MENQOL through internal consistency reliability with Cronbach's α and intersubscale correlations. Item-domain correlations, principal components analysis (PCA), and confirmatory factor analysis were performed to determine construct validity. t tests were used to compare the differences between the menopausal symptomatic and asymptomatic women and to evaluate the discriminate validity. Pearson correlation coefficients were calculated between MENQOL scores and the Kupperman index to assess criterion-related validity. The most common symptoms in Chinese menopausal symptomatic women were "experiencing poor memory" (94.4%), "feeling tired or worn out" (93.8%), "aching in muscle and joints" (89.4%), "low backache" (86.9%), "decrease in physical strength" (86.6%), "aches in back of neck or head" (86.2%), "difficulty sleeping" (83.6%), "accomplishing less than I used to" (83.4%), "feeling a lack of energy" (83.3%), "change in your sexual desire" (81%), and "hot flash" (80.7%) among others. The symptoms of "increased facial hair" were rarely seen (9.9%). The vasomotor domain, as well as psychosocial, physical, and sexual domains showed high reliability (Cronbach's α 0.84, 0.87, 0.89, and 0.86, respectively). Item-domain correlation analysis showed that all items correlated more strongly with their own domains than with other domains. In the PCA, after deleting the "increased facial hair" item, items in the vasomotor, sexual, and psychosocial subscales loaded on their respective domains by and large, and items in the physical subscale divided into two factors. The PCA revealed a latent structure of the Chinese version of MENQOL nearly identical to the original MENQOL domains. The confirmatory factor analysis demonstrated that the questionnaire fits well with a four-domain model. The MENQOL can discriminate between menopausal symptomatic women with asymptomatic women as it showed good discriminate validity. Criterion-related validity was confirmed by a significant correlation between MENQOL scores and the Kupperman index. This study showed that Chinese version of MENQOL has good psychometric properties and would be suitable to measure the health-related quality-of-life of Chinese menopausal women except for item 21 (increased facial hair).

Cutaneous microvascular perfusion responses to insulin iontophoresis are differentially affected by insulin resistance after spinal cord injury.

PubMed

La Fountaine, Michael F; Cirnigliaro, Christopher M; Azarelo, Frank; Hobson, Joshua C; Tascione, Oriana; Swonger, Kirsten N; Dyson-Hudson, Trevor; Bauman, William A

2017-09-01

What is the central question of this study? What impact does insulin resistance have on cutaneous perfusion responses to insulin iontophoresis in vascular beds with markedly reduced or functionally ablated sympathetic nervous system vasomotor function resulting from spinal cord injury? What is the main finding and its importance? Persons with spinal cord injury have sublesional microvascular endothelial dysfunction, as indicated by a blunted cutaneous perfusion response to acetylcholine iontophoresis, and the presence of insulin resistance has a further confounding effect on endothelium-mediated changes to cutaneous perfusion in the lower extremities. Endothelium-mediated mechanisms that regulate skin blood flow might play an integral role in optimizing skin perfusion in vascular beds with sympathetic nervous system vasomotor impairment, such as in spinal cord injury (SCI). Insulin is a vasoactive hormone and second messenger of nitric oxide that facilitates endothelium-mediated dilatation. The effects of insulin resistance (IR) on sublesional cutaneous perfusion responses to insulin provocation have yet to be described in persons with SCI. Persons with SCI and an able-bodied (AB) cohort were divided into subgroups based upon fasting plasma insulin concentration cut-offs for IR (≥13.13 mIU ml -1 ) or insulin sensitivity (IS; <13.13 mIU ml -1 ), as follows: AB, IS (ABIS, n = 21); SCI, IS (SCIS, n = 21); AB, IR (ABIR, n = 9); and SCI, IR (SCIR, n = 11). Laser Doppler flowmetry characterized peak blood perfusion unit (BPU) responses (percentage change from baseline) to insulin, acetylcholine or placebo iontophoresis in the lower extremities; BPU responses were log 10 transformed to facilitate comparisons, and the net insulin response (NetIns) BPU response was calculated (insulin minus placebo BPU response). The NetIns was significantly greater in both IS groups compared with their corresponding IR group. The acetylcholine-mediated BPU responses in the SCI subgroups were significantly lower than those in the ABIS group. The proportional BPU responses of NetIns to acetylcholine in the IS cohorts (i.e. ABIS and SCIS) were significantly greater (P < 0.05) than that of each IR subgroup. The presence of IR has a confounding effect on sublesional microvascular endothelium-mediated cutaneous perfusion responses to provocation. Preservation of endothelial sensitivity to its agonists appears to be an important modifiable risk factor to optimize cutaneous perfusion in the lower extremities of persons with SCI. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Hypoxia-inducible factor-1α in vascular smooth muscle regulates blood pressure homeostasis through a peroxisome proliferator-activated receptor-γ-angiotensin II receptor type 1 axis.

PubMed

Huang, Yan; Di Lorenzo, Annarita; Jiang, Weidong; Cantalupo, Anna; Sessa, William C; Giordano, Frank J

2013-09-01

Hypertension is a major worldwide health issue for which only a small proportion of cases have a known mechanistic pathogenesis. Of the defined causes, none have been directly linked to heightened vasoconstrictor responsiveness, despite the fact that vasomotor tone in resistance vessels is a fundamental determinant of blood pressure. Here, we reported a previously undescribed role for smooth muscle hypoxia-inducible factor-1α (HIF-1α) in controlling blood pressure homeostasis. The lack of HIF-1α in smooth muscle caused hypertension in vivo and hyperresponsiveness of resistance vessels to angiotensin II stimulation ex vivo. These data correlated with an increased expression of angiotensin II receptor type I in the vasculature. Specifically, we show that HIF-1α, through peroxisome proliferator-activated receptor-γ, reciprocally defined angiotensin II receptor type I levels in the vessel wall. Indeed, pharmacological blockade of angiotensin II receptor type I by telmisartan abolished the hypertensive phenotype in smooth muscle cell-HIF-1α-KO mice. These data revealed a determinant role of a smooth muscle HIF-1α/peroxisome proliferator-activated receptor-γ/angiotensin II receptor type I axis in controlling vasomotor responsiveness and highlighted an important pathway, the alterations of which may be critical in a variety of hypertensive-based clinical settings.

Syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) in a patient with confusional symptoms, diffuse EEG abnormalities, and bilateral vasospasm in transcranial Doppler ultrasound: A case report and literature review.

PubMed

Hidalgo de la Cruz, M; Domínguez Rubio, R; Luque Buzo, E; Díaz Otero, F; Vázquez Alén, P; Orcajo Rincón, J; Prieto Montalvo, J; Contreras Chicote, A; Grandas Pérez, F

2017-04-17

HaNDL syndrome (transient headache and neurological deficits with cerebrospinal fluid lymphocytosis) is characterised by one or more episodes of headache and transient neurological deficits associated with cerebrospinal fluid lymphocytosis. To date, few cases of HaNDL manifesting with confusional symptoms have been described. Likewise, very few patients with HaNDL and confusional symptoms have been evaluated with transcranial Doppler ultrasound (TCD). TCD data from patients with focal involvement reveal changes consistent with vasomotor alterations. We present the case of a 42-year-old man who experienced headache and confusional symptoms and displayed pleocytosis, diffuse slow activity on EEG, increased blood flow velocity in both middle cerebral arteries on TCD, and single-photon emission computed tomography (SPECT) findings suggestive of diffuse involvement, especially in the left hemisphere. To our knowledge, this is the first description of a patient with HaNDL, confusional symptoms, diffuse slow activity on EEG, and increased blood flow velocity in TCD. Our findings suggest a relationship between cerebral vasomotor changes and the pathophysiology of HaNDL. TCD may be a useful tool for early diagnosis of HaNDL. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Omega-3 versus isoflavones in the control of vasomotor symptoms in postmenopausal women.

PubMed

Palacios, S; Lilue, M; Mejia, A; Menendez, C

2017-12-01

Determine the efficacy and tolerability of omega-3 fatty acids versus soybean isoflavones in reducing the vasomotor symptoms (VMSs) frequency in postmenopausal women. A randomized, prospective, two-arm study was performed in healthy postmenopausal women aged 45-65. The two arms were: two capsules/day of omega-3 (425 mg of omega-3/capsule) administered orally (n = 38) and two tablets/day of soybean isoflavones (54.4 mg of isoflavones/tablet) (n = 30), over 16 weeks. The mean baseline frequency of moderate and severe VMSs per week in the omega-3 group was 24.56 and 23.90, respectively, and 19.65 and 19.51 in the isoflavone group. After 4 months, the reduction in moderate and severe hot flashes with omega-3 was significant (p < .001), whereas in the case of isoflavones, there was a significant difference in severe (p = .02) hot flashes after 4 months, but not in moderate hot flashes (p = .077). Omega-3 did not demonstrate significant efficacy differences versus isoflavones over time. The use of omega-3 has a beneficial effect on hot flash reduction after 4 months of treatment. This is comparable to the benefits found with soybean isoflavones after 3-4 weeks and after 4 months in severe hot flash women, but higher than those found with soybean isoflavones in moderate symptom women.

Migraine generator network and spreading depression dynamics as neuromodulation targets in episodic migraine

NASA Astrophysics Data System (ADS)

Dahlem, Markus A.

2013-12-01

Migraine is a common disabling headache disorder characterized by recurrent episodes sometimes preceded or accompanied by focal neurological symptoms called aura. The relation between two subtypes, migraine without aura (MWoA) and migraine with aura (MWA), is explored with the aim to identify targets for neuromodulation techniques. To this end, a dynamically regulated control system is schematically reduced to a network of the trigeminal nerve, which innervates the cranial circulation, an associated descending modulatory network of brainstem nuclei, and parasympathetic vasomotor efferents. This extends the idea of a migraine generator region in the brainstem to a larger network and is still simple and explicit enough to open up possibilities for mathematical modeling in the future. In this study, it is suggested that the migraine generator network (MGN) is driven and may therefore respond differently to different spatio-temporal noxious input in the migraine subtypes MWA and MWoA. The noxious input is caused by a cortical perturbation of homeostasis, known as spreading depression (SD). The MGN might even trigger SD in the first place by a failure in vasomotor control. As a consequence, migraine is considered as an inherently dynamical disease to which a linear course from upstream to downstream events would not do justice. Minimally invasive and noninvasive neuromodulation techniques are briefly reviewed and their rational is discussed in the context of the proposed mechanism.

[Obesity as pathology of adipocytes: number of cells, volume of arterial bloodstream,local pools of circulation in vivo, natriuretic peptides and arterial hypertension].

PubMed

Titov, V N; Dmitriev, V A

2015-03-01

The non-specific systemic biological reaction of arterial pressure from the level of organism. vasomotor center and proximal section of arterial bloodstream is appealed to compensate disorders of metabolism and microcirculation in distal section of arteries. This phenomenon occurs in several cases. The primarily local disorders of metabolism at autocrine level, physiological (aphysiological) death of cells, "littering" of intercellular medium become the cause of disorder of microcirculation in paracrin cenosises and deteriorate realization of biological functions of homeostasis, trophology, endoecology and adaptation. The local compensation of affected perfusion in paracrin cenosises at the expense of function of peripheral peristaltic pumps, redistribution of local bloodflow in biological reaction of endothelium-depended vaso-dilation has no possibility to eliminate disorders in realization of biological functions. The systemic increase of arterial pressure under absence of specific symptoms of symptomatic arterial hypertension is a test to detect disorder of biological functions of homeostasis, trophology, biological function of endoecology and adaptation. Allforms of arterial hypertension develop by common algorithm independently from causes of disorders of blood flow, microcirculation in distal section of arteries. The non-specific systemic compensation ofdisorders of metabolism from level of organism, in proximal section of arterial bloodstream always is the same one and results in aphysiological alterations in organs-targets. To comprehend etiological characteristics of common pathogenesis of arterial hypertension is possible in case of application of such technically complicated and still unclear in differential diagnostic of deranged functions modes of metabolomics.

Laser-assisted surgery of endonasal diseases

NASA Astrophysics Data System (ADS)

Sroka, Ronald; Leunig, Andreas; Janda, P.; Rosler, P.; Grevers, G.; Baumgartner, Reinhold

2000-06-01

Clinical studies were performed to assess the clinical outcome of laser assisted endonasal turbinate surgery in long-term. By means of a pulsed Ho:YAG laser emitting at (lambda) equals 2100nm 57 patients suffering form nasal obstruction due to allergic rhinitis and vasomotoric rhinitis were treated under local anesthesia. Furthermore 50 patients were treated by means of light of a diode laser. The light was fed into a fiber being introduced into a fiber guidance system which serves for suction of smoke and pyrolyse products. The distal part of this system could be bent in the range of -5 degrees up to 45 degrees due to the optical axes of the fiber. The study was conducted by a standardized questionnaire, photo documentation, allergy test, mucocilliar function test, rhinomanometry, radiology and histology. Within 2 weeks after laser treatment a significant improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined. This effect lasted up until 1 year post treatment resulting in an improved quality of life in more than 80 percent of the patients. Side effects like nasal dryness and pain were rare, no immediate complications were observed. The total treatment time took 3-8 minutes/turbinate and nasal packing was not necessary after the laser procedure. In conclusion laser treatment by means of the fiber guidance system can be performed as an outpatient procedure under local anesthesia with excellent ablation of soft tissue in a short treatment time with promising results. It will become a time and cost effective treatment modality in endonasal laser surgery.

The association between pre-treatment occupational skill level and mood and symptom burden in early-stage, postmenopausal breast cancer survivors during the first year of anastrozole therapy.

PubMed

Nugent, Bethany D; Sereika, Susan M; Rosenzweig, Margaret; McCue, Michael; Merriman, John D; Bender, Catherine M

2016-08-01

Previous research has explored occupational activity of breast cancer survivors but has not examined the influence of occupational level on symptoms prospectively. The purpose of this study was to examine the relationship between occupational classification and changes in mood and symptom burden for postmenopausal breast cancer survivors during the first year of anastrozole therapy. This was an exploratory secondary analysis in 49 postmenopausal women receiving anastrozole therapy for early-stage breast cancer. Participants reported their occupation at baseline and completed self-report questionnaires measuring mood and symptom burden at baseline, 6 months, and 12 months. Occupation was classified according to four major skill levels delineated by the International Standard Classification of Occupations (ISCO). Breast cancer survivors employed at occupational skill levels 1 through 3 reported significantly higher depressive symptoms, fatigue, and total symptoms on average than those employed at ISCO skill level 4. After adjusting for multiple comparisons, this pattern remained for the musculoskeletal, vasomotor, and gastrointestinal symptom subscales. Breast cancer survivors employed at lower skill levels (i.e., ISCO 1-3) reported poorer mood and greater symptom burden than breast cancer survivors employed at a higher skill level (i.e., ISCO 4). Assessing baseline occupation of occupationally active breast cancer survivors may improve understanding of the association between types of occupations and mood and symptom trajectories and may inform development of interventions to mitigate symptom severity in order to help breast cancer survivors maintain optimal occupational function and adherence to therapy.

The Association between Pre-treatment Occupational Skill Level and Mood and Symptom Burden in Early-stage, Postmenopausal, Breast Cancer Survivors during the First Year of Anastrozole Therapy

PubMed Central

Nugent, Bethany D.; Sereika, Susan M.; Rosenzweig, Margaret; McCue, Michael; Merriman, John D.; Bender, Catherine M.

2016-01-01

Purpose Previous research has explored occupational activity of breast cancer survivors but has not examined the influence of occupational level on symptoms prospectively. The purpose of this study was to examine the relationship between occupational classification and changes in mood and symptom burden for postmenopausal breast cancer survivors during the first year of anastrozole therapy. Methods This was an exploratory secondary analysis in 49 postmenopausal women receiving anastrozole therapy for early-stage breast cancer. Participants reported their occupation at baseline and completed self-report questionnaires measuring mood and symptom burden at baseline, 6 and 12 months. Occupation was classified according to 4 major Skill Levels delineated by the International Standard Classification of Occupations (ISCO). Results Breast cancer survivors employed at occupational Skill Levels 1 through 3 reported significantly higher depressive symptoms, fatigue, and total symptoms on average than those employed at ISCO Skill Level 4. After adjusting for multiple comparisons, this pattern remained for the musculoskeletal, vasomotor, and gastrointestinal symptom subscales. Conclusions Breast cancer survivors employed at lower Skill Levels (i.e., ISCO 1–3) reported poorer mood and greater symptom burden than breast cancer survivors employed at a higher Skill Level (i.e., ISCO 4). Assessing baseline occupation of occupationally active breast cancer survivors may improve understanding of the association between types of occupations and mood and symptom trajectories and may inform development of interventions to mitigate symptom severity in order to help breast cancer survivors maintain optimal occupational function and adherence to therapy. PMID:26984246

Sympathetic vasoconstriction and orthostatic intolerance after simulated microgravity.

PubMed

Kamiya, A; Michikami, D; Fu, Q; Iwase, S; Mano, T

1999-07-01

Upon a return to the earth from spaceflight, astronauts often become presyncope during standing. This orthostatic intolerance is provoked by the exposure to the stimulation model of microgravitational environment in humans, 6 degrees head-down bed rest (HDBR). The mechanism for the orthostatic hypotension after microgravity remains unclear. It has been reported that a microgravity-induced loss of circulatory blood volume, a withdrawal of vagal tone, or a reduction of carotid-cardiac baroreflex function may relate to this phenomenon. A recent article has reported that astronauts who showed presyncopal events after spaceflight had subnormal increases in plasma norepinephrine under the standing tests, suggesting that a hypoadrenergic responsiveness to orthostatic stress may partly contribute to postflight orthostatic hypotension. However, it is unclear how and whether or not the sympathetic outflow to peripheral vessels and the release of norepinephrine from sympathetic nerve terminals were altered after microgravity. The vasomotor sympathetic outflow to the skeletal muscle can be directly recorded as muscle sympathetic nerve activity (MSNA) using a microneurographic technique. In addition, the rate of an increase in plasma norepinephrine per that in MSNA in response to applied orthostatic stress can partly indicate the norepinephrine release to sympathetic stimuli as a trial assessment. Therefore, we performed 60 degrees head-up tilt (HUT) tests before and after 14 days of HDBR, and examined the differences in the MSNA response and the indicated norepinephrine release during HUT tests between the subjects who did (defined as the fainters) and those who did not (defined as the nonfainters) become presyncopal in HUT tests after HDBR.

Advanced life systems hardware development for future missions

NASA Technical Reports Server (NTRS)

1975-01-01

An examination of the pulse formation in an externalized vessel suggests that the vessel does not behave as a simple visco-elastic tube. Pressure-pulse waveform transducers are sensitive either to the pressure present at the vessel wall or to the volume of blood filling a region of tissue. Results of comparisons between intra-and extra-vascular pressure recordings suggest that changes in vasomotor tone and transducer-vessel pressures may be the greatest contributors to the divergence of extra-vascular waveforms from intra-vascular waveforms.

Combined short-arm centrifuge and aerobic exercise training improves cardiovascular function and physical working capacity in humans.

PubMed

Yang, Chang-Bin; Zhang, Shu; Zhang, Yu; Wang, Bing; Yao, Yong-Jie; Wang, Yong-Chun; Wu, Yan-Hong; Liang, Wen-Bin; Sun, Xi-Qing

2010-12-01

Musculoskeletal and cardiovascular deconditioning occurring in long-term spaceflight gives rise to the needs to develop new strategies to counteract these adverse effects. Short-arm centrifuge combined with ergometer has been proposed as a strategy to counteract adverse effects of microgravity. This study sought to investigate whether the combination of short-arm centrifuge and aerobic exercise training have advantages over short-arm centrifuge or aerobic exercise training alone. One week training was conducted by 24 healthy men. They were randomly divided into 3 groups: (1) short-arm centrifuge training, (2) aerobic exercise training, 40 W, and (3) combined short-arm centrifuge and aerobic exercise training. Before and after training, the cardiac pump function represented by stroke volume, cardiac output, left ventricular ejection time, and total peripheral resistance was evaluated. Variability of heart rate and systolic blood pressure were determined by spectral analysis. Physical working capacity was surveyed by near maximal physical working capacity test. The 1-week combined short-arm centrifuge and aerobic exercise training remarkably ameliorated the cardiac pump function and enhanced vasomotor sympathetic nerve modulation and improved physical working capacity by 10.9% (P<.05, n=8). In contrast, neither the short-arm centrifuge nor the aerobic exercise group showed improvements in these functions. These results demonstrate that combined short-arm centrifuge and aerobic exercise training has advantages over short-arm centrifuge or aerobic exercise training alone in influencing several physiologically important cardiovascular functions in humans. The combination of short-arm centrifuge and aerobic exercise offers a promising countermeasure to microgravity.

Gender-related asymmetric brain vasomotor response to color stimulation: a functional transcranial Doppler spectroscopy study.

PubMed

Njemanze, Philip C

2010-11-30

The present study was designed to examine the effects of color stimulation on cerebral blood mean flow velocity (MFV) in men and women. The study included 16 (8 men and 8 women) right-handed healthy subjects. The MFV was recorded simultaneously in both right and left middle cerebral arteries in Dark and white Light conditions, and during color (Blue, Yellow and Red) stimulations, and was analyzed using functional transcranial Doppler spectroscopy (fTCDS) technique. Color processing occurred within cortico-subcortical circuits. In men, wavelength-differencing of Yellow/Blue pairs occurred within the right hemisphere by processes of cortical long-term depression (CLTD) and subcortical long-term potentiation (SLTP). Conversely, in women, frequency-differencing of Blue/Yellow pairs occurred within the left hemisphere by processes of cortical long-term potentiation (CLTP) and subcortical long-term depression (SLTD). In both genders, there was luminance effect in the left hemisphere, while in men it was along an axis opposite (orthogonal) to that of chromatic effect, in women, it was parallel. Gender-related differences in color processing demonstrated a right hemisphere cognitive style for wavelength-differencing in men, and a left hemisphere cognitive style for frequency-differencing in women. There are potential applications of fTCDS technique, for stroke rehabilitation and monitoring of drug effects.

Effects of acupuncture on menopause-related symptoms and quality of life in women in natural menopause: a meta-analysis of randomized controlled trials.

PubMed

Chiu, Hsiao-Yean; Pan, Chieh-Hsin; Shyu, Yuh-Kae; Han, Bor-Cheng; Tsai, Pei-Shan

2015-02-01

This meta-analysis aims to evaluate the effects of acupuncture on hot flash frequency and severity, menopause-related symptoms, and quality of life in women in natural menopause. We systematically searched PubMed/Medline, PsychINFO, Web of Science, Cochrane Central Register of Controlled Trials, and CINAHL using keywords such as acupuncture, hot flash, menopause-related symptoms, and quality of life. Heterogeneity, moderator analysis, publication bias, and risk of bias associated with the included studies were examined. Of 104 relevant studies, 12 studies with 869 participants met the inclusion criteria and were included in this study. We found that acupuncture significantly reduced the frequency (g = -0.35; 95% CI, -0.5 to -0.21) and severity (g = -0.44; 95% CI, -0.65 to -0.23) of hot flashes. Acupuncture significantly decreased the psychological, somatic, and urogenital subscale scores on the Menopause Rating Scale (g = -1.56, g = -1.39, and g = -0.82, respectively; P < 0.05). Acupuncture improved the vasomotor subscale score on the Menopause-Specific Quality of Life questionnaire (g= -0.46; 95% CI, -0.9 to -0.02). Long-term effects (up to 3 mo) on hot flash frequency and severity (g = -0.53 and g = -0.55, respectively) were found. This meta-analysis confirms that acupuncture improves hot flash frequency and severity, menopause-related symptoms, and quality of life (in the vasomotor domain) in women experiencing natural menopause.

[Evaluation of the efficacy of a new nutraceutical product in the treatment of postmenopausal symptoms].

PubMed

Cappelli, V; Morgante, G; Di Sabatino, A; Massaro, M G; De Leo, V

2015-12-01

The onset of vasomotor symptoms in postmenopausal women represents the beginning of a hard period from the emotional point of view which involves some of the most important neurotransmitters. Hot flushes and insomnia associated with a state of anxiety that affect postmenopausal women are included in an index known as the Kupperman Index. The use of nutraceuticals in Italy is increasingly widespread, and only 6-8% of women currently choose to take hormone replacement therapy. The action of these natural supplements primarily depends on the selection of substances and the dose of each single ingredient. Moreover, it also depends on the range of vasomotor symptoms (from mild to moderate/severe). The aim of this study was to test the action of a new product without phytoestrogens containing Cimicifuga racemosa, chasteberry (Vitex agnus-castus), hyaluronic acid, zinc and ginger (ElleN®) in two different groups of women: one with mild and the other with moderate/severe menopausal symptoms. All women received a dose of one tablet per day of ElleN® for three months. Results showed a significant reduction in the Kupperman Index in both groups. The treatment was particularly effective against hot flushes associated with night insomnia and anxiety. The product was well tolerated, did not cause any side effects, and none of the subjects dropped out of the study. In conclusion, it can be stated that the supplement evaluated in the present study is able to reduce moderate/severe menopause symptoms.

Is anxiety associated with hot flashes in women with breast cancer?

PubMed

Guimond, Anne-Josée; Massicotte, Elsa; Savard, Marie-Hélène; Charron-Drolet, Jade; Ruel, Sophie; Ivers, Hans; Savard, Josée

2015-08-01

Women with breast cancer are at higher risk for experiencing hot flashes (HFs), which is attributable, in large part, to systemic cancer treatments and their effects on estrogen levels. However, other factors, such as anxiety, could also play a role. This study aimed to assess the cross-sectional and temporal relationships between anxiety and HFs among women treated for breast cancer and to clarify the direction of these relationships. Fifty-six women recently treated for breast cancer were assessed prospectively using a 14-day Hot Flashes and Anxiety Diary (HFAD). Anxiety and HFs were also assessed using the Hospital Anxiety and Depression Scale-anxiety subscale and the Menopause-Specific Quality of Life Questionnaire-vasomotor subscale. In addition, HFs were objectively recorded for a continuous 24-hour period using home-based sternal skin conductance. No cross-sectional relationship was found between anxiety and subjectively assessed HFs, or between anxiety and the frequency and intensity of objectively assessed HFs. However, a greater anxiety level on the HFAD was significantly associated with a shorter time to reach the HF peak, as assessed with sternal skin conductance (partial Spearman correlation coefficient rsp = -0.44). Moreover, greater anxiety predicted more severe self-reported HFs on the following night, both assessed with the HFAD (rsp = 0.13). Conversely, self-reported diurnal and nocturnal HFs on the HFAD did not predict next-day anxiety level. This study reveals a significant relationship between anxiety and faster-developing objectively measured HFs. Furthermore, anxiety has been found to significantly predict subsequent increases in self-reported HFs, suggesting that strategies that target anxiety could potentially have a beneficial effect on HFs in women with breast cancer.

Positron Emission Tomography-Determined Hyperemic Flow, Myocardial Flow Reserve, and Flow Gradient—Quo Vadis?

PubMed Central

Leucker, Thorsten M.; Valenta, Ines; Schindler, Thomas Hellmut

2017-01-01

Positron emission tomography/computed tomography (PET/CT) applied with positron-emitting flow tracers such as 13N-ammonia and 82Rubidium enables the quantification of both myocardial perfusion and myocardial blood flow (MBF) in milliliters per gram per minute for coronary artery disease (CAD) detection and characterization. The detection of a regional myocardial perfusion defect during vasomotor stress commonly identifies the culprit lesion or most severe epicardial narrowing, whereas adding regional hyperemic MBFs, myocardial flow reserve (MFR), and/or longitudinal flow decrease may also signify less severe but flow-limiting stenosis in multivessel CAD. The addition of regional hyperemic flow parameters, therefore, may afford a comprehensive identification and characterization of flow-limiting effects of multivessel CAD. The non-specific origin of decreases in hyperemic MBFs and MFR, however, prompts an evaluation and interpretation of regional flow in the appropriate context with the presence of obstructive CAD. Conversely, initial results of the assessment of a longitudinal hyperemic flow gradient suggest this novel flow parameter to be specifically related to increases in CAD caused epicardial resistance. The concurrent assessment of myocardial perfusion and several hyperemic flow parameters with PET/CT may indeed open novel avenues of precision medicine to guide coronary revascularization procedures that may potentially lead to a further improvement in cardiovascular outcomes in CAD patients. PMID:28770213

Evaluation of autonomic functions of patients with multiple system atrophy and Parkinson's disease by head-up tilt test.

PubMed

Watano, Chikako; Shiota, Yuri; Onoda, Keiichi; Sheikh, Abdullah Md; Mishima, Seiji; Nitta, Eri; Yano, Shozo; Yamaguchi, Shuhei; Nagai, Atsushi

2018-02-01

The aim of this study was to evaluate the autonomic neural function in Parkinson's disease (PD) and multiple system atrophy (MSA) with head-up tilt test and spectral analysis of cardiovascular parameters. This study included 15 patients with MSA, 15 patients with PD, and 29 healthy control (HC) subjects. High frequency power of the RR interval (RR-HF), the ratio of low frequency power of RR interval to RR-HF (RR-LF/HF) and LF power of systolic BP were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively. Both patients with PD and MSA showed orthostatic hypotension and lower parasympathetic function (RR-HF) at tilt position as compared to HC subjects. Cardiac sympathetic function (RR-LF/HF) was significantly high in patients with PD than MSA at supine position. RR-LF/HF tended to increase in MSA and HC, but decreased in PD by tilting. Consequently, the change of the ratio due to tilting (ΔRR-LF/HF) was significantly lower in patients with PD than in HC subjects. Further analysis showed that compared to mild stage of PD, RR-LF/HF at the supine position was significantly higher in advanced stage. By tilting, it was increased in mild stage and decreased in the advanced stage of PD, causing ΔRR-LF/HF to decrease significantly in the advanced stage. Thus, we demonstrated that spectral analysis of cardiovascular parameters is useful to identify sympathetic and parasympathetic disorders in MSA and PD. High cardiac sympathetic function at the supine position, and its reduction by tilting might be a characteristic feature of PD, especially in the advanced stage.

The beneficial effects of massage therapy for insomnia in postmenopausal women.

PubMed

Hachul, H; Oliveira, D S; Bittencourt, L R A; Andersen, M L; Tufik, S

2014-06-01

With increases life expectancy, the incidence of undesirable manifestations of menopause has increased as well. The effects of lost ovarian function include progressive decrease in estradiol secretion, trophic changes in the breast, vasomotor symptoms, anxiety, depression, and sleep disorders. Insomnia, which has physiological consequences and can result in a loss of quality of life, is prevalent in women after menopause. Hormone therapy has been widely used to reduce menopausal symptoms, but its use in recent years has been questioned because of the reported risks of cardiovascular events and increased incidence of tumors. This controversy has generated significant interest in non-hormonal treatments among both physicians and patients. Our previous research has shown a positive effect of massage therapy on menopausal symptoms. We explored the hypothesis that massage therapy would produce beneficial effects in postmenopausal women through inflammatory and immunological changes. Recent results from self-report questionnaires have shown improvements in sleep pattern and quality of life following massage therapy. These findings demonstrate the effectiveness of massage therapy for the treatment of postmenopausal symptoms, particularly insomnia, and indicate that it is a promising line of research.

Endothelial dysfunction and amyloid-β-induced neurovascular alterations

PubMed Central

Koizumi, Kenzo; Wang, Gang; Park, Laibaik

2015-01-01

Alzheimer's disease (AD) and cerebrovascular diseases share common vascular risk factors that have disastrous effects on cerebrovascular regulation. Endothelial cells, lining inner walls of cerebral blood vessels, form a dynamic interface between the blood and the brain and are critical for the maintenance of neurovascular homeostasis. Accordingly, injury in endothelial cells is regarded as one of the earliest symptoms of impaired vasoregulatory mechanisms. Extracellular buildup of amyloid-β (Aβ) is a central pathogenic factor in AD. Aβ exerts potent detrimental effects on cerebral blood vessels and impairs endothelial structure and function. Recent evidence implicates vascular oxidative stress and activation of the nonselective cationic channel transient receptor potential melastatin (TRPM)-2 on endothelial cells in the mechanisms of Aβ-induced neurovascular dysfunction. Thus, Aβ triggers opening of TRPM2 channels in endothelial cells leading to intracellular Ca2+ overload and vasomotor dysfunction. The cerebrovascular dysfunction may contribute to AD pathogenesis by reducing the cerebral blood supply, leading to increased susceptibility to vascular insufficiency, and by promoting Aβ accumulation. The recent realization that vascular factors contribute to AD pathobiology suggests new targets for the prevention and treatment of this devastating disease. PMID:26328781

Hypoxia inducible factor 1 (HIF-1) and cardioprotection

PubMed Central

Tekin, Demet; Dursun, Ali D; Xi, Lei

2010-01-01

Since its discovery in early 1990s, hypoxia inducible factor 1 (HIF-1) has been increasingly recognized for its key role in transcriptional control of more than a hundred genes that regulate a wide-spectrum of cellular functional events, including angiogenesis, vasomotor control, glucose and energy metabolism, erythropoiesis, iron homeostasis, pH regulation, cell proliferation and viability. Evidence accumulated during the past 7 years suggests a critical role for HIF-1α in mediating cardioprotection. The purpose of our present article is to provide an updated overview on this important regulator of gene expression in the cellular stress-responsive and adaptive process. We have particularly emphasized the involvement of HIF-1 in the induction of cardioprotective molecules, such as inducible nitric oxide synthase (iNOS), hemeoxygenase 1 (HO-1), and erythropoietin (EPO), which in turn alleviate myocardial damages caused by harmful events such as ischemia-reperfusion injury. Despite these advances, further in-depth studies are needed to elucidate the possible coordination or interaction between HIF-1α and other key transcription factors in regulating protein expression that leads to cardioprotection. PMID:20711226

Microvascular responsiveness in obesity: implications for therapeutic intervention

PubMed Central

Bagi, Zsolt; Feher, Attila; Cassuto, James

2012-01-01

Obesity has detrimental effects on the microcirculation. Functional changes in microvascular responsiveness may increase the risk of developing cardiovascular complications in obese patients. Emerging evidence indicates that selective therapeutic targeting of the microvessels may prevent life-threatening obesity-related vascular complications, such as ischaemic heart disease, heart failure and hypertension. It is also plausible that alterations in adipose tissue microcirculation contribute to the development of obesity. Therefore, targeting adipose tissue arterioles could represent a novel approach to reducing obesity. This review aims to examine recent studies that have been focused on vasomotor dysfunction of resistance arteries in obese humans and animal models of obesity. Particularly, findings in coronary resistance arteries are contrasted to those obtained in other vascular beds. We provide examples of therapeutic attempts, such as use of statins, ACE inhibitors and insulin sensitizers to prevent obesity-related microvascular complications. We further identify some of the important challenges and opportunities going forward. LINKED ARTICLES This article is part of a themed section on Fat and Vascular Responsiveness. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-3 PMID:21797844

Magnesium in Disease Prevention and Overall Health12

PubMed Central

Volpe, Stella Lucia

2013-01-01

Magnesium is the fourth most abundant mineral and the second most abundant intracellular divalent cation and has been recognized as a cofactor for >300 metabolic reactions in the body. Some of the processes in which magnesium is a cofactor include, but are not limited to, protein synthesis, cellular energy production and storage, reproduction, DNA and RNA synthesis, and stabilizing mitochondrial membranes. Magnesium also plays a critical role in nerve transmission, cardiac excitability, neuromuscular conduction, muscular contraction, vasomotor tone, blood pressure, and glucose and insulin metabolism. Because of magnesium’s many functions within the body, it plays a major role in disease prevention and overall health. Low levels of magnesium have been associated with a number of chronic diseases including migraine headaches, Alzheimer’s disease, cerebrovascular accident (stroke), hypertension, cardiovascular disease, and type 2 diabetes mellitus. Good food sources of magnesium include unrefined (whole) grains, spinach, nuts, legumes, and white potatoes (tubers). This review presents recent research in the areas of magnesium and chronic disease, with the goal of emphasizing magnesium’s role in disease prevention and overall health. PMID:23674807

The beneficial effects of massage therapy for insomnia in postmenopausal women☆

PubMed Central

Hachul, H.; Oliveira, D.S.; Bittencourt, L.R.A.; Andersen, M.L.; Tufik, S.

2014-01-01

With increases life expectancy, the incidence of undesirable manifestations of menopause has increased as well. The effects of lost ovarian function include progressive decrease in estradiol secretion, trophic changes in the breast, vasomotor symptoms, anxiety, depression, and sleep disorders. Insomnia, which has physiological consequences and can result in a loss of quality of life, is prevalent in women after menopause. Hormone therapy has been widely used to reduce menopausal symptoms, but its use in recent years has been questioned because of the reported risks of cardiovascular events and increased incidence of tumors. This controversy has generated significant interest in non-hormonal treatments among both physicians and patients. Our previous research has shown a positive effect of massage therapy on menopausal symptoms. We explored the hypothesis that massage therapy would produce beneficial effects in postmenopausal women through inflammatory and immunological changes. Recent results from self-report questionnaires have shown improvements in sleep pattern and quality of life following massage therapy. These findings demonstrate the effectiveness of massage therapy for the treatment of postmenopausal symptoms, particularly insomnia, and indicate that it is a promising line of research. PMID:26483913

Neural blockade during exercise augments central command's contribution to carotid baroreflex resetting

NASA Technical Reports Server (NTRS)

Querry, R. G.; Smith, S. A.; Stromstad, M.; Ide, K.; Raven, P. B.; Secher, N. H.

2001-01-01

This investigation was designed to determine central command's role on carotid baroreflex (CBR) resetting during exercise. Nine volunteer subjects performed static and rhythmic handgrip exercise at 30 and 40% maximal voluntary contraction (MVC), respectively, before and after partial axillary neural blockade. Stimulus-response curves were developed using the neck pressure-neck suction technique and a rapid pulse train protocol (+40 to -80 Torr). Regional anesthesia resulted in a significant reduction in MVC. Heart rate (HR) and ratings of perceived exertion (RPE) were used as indexes of central command and were elevated during exercise at control force intensity after induced muscle weakness. The CBR function curves were reset vertically with a minimal lateral shift during control exercise and exhibited a further parallel resetting during exercise with neural blockade. The operating point was progressively reset to coincide with the centering point of the CBR curve. These data suggest that central command was a primary mechanism in the resetting of the CBR during exercise. However, it appeared that central command modulated the carotid-cardiac reflex proportionately more than the carotid-vasomotor reflex.

CaMKII Regulates Synaptic NMDA Receptor Activity of Hypothalamic Presympathetic Neurons and Sympathetic Outflow in Hypertension.

PubMed

Li, De-Pei; Zhou, Jing-Jing; Zhang, Jixiang; Pan, Hui-Lin

2017-11-01

NMDAR activity in the hypothalamic paraventricular nucleus (PVN) is increased and critically involved in heightened sympathetic vasomotor tone in hypertension. Calcium/calmodulin-dependent protein kinase II (CaMKII) binds to and modulates NMDAR activity. In this study, we determined the role of CaMKII in regulating NMDAR activity of PVN presympathetic neurons in male spontaneously hypertensive rats (SHRs). NMDAR-mediated EPSCs and puff NMDA-elicited currents were recorded in spinally projecting PVN neurons in SHRs and male Wistar-Kyoto (WKY) rats. The basal amplitude of evoked NMDAR-EPSCs and puff NMDA currents in retrogradely labeled PVN neurons were significantly higher in SHRs than in WKY rats. The CaMKII inhibitor autocamtide-2-related inhibitory peptide (AIP) normalized the increased amplitude of NMDAR-EPSCs and puff NMDA currents in labeled PVN neurons in SHRs but had no effect in WKY rats. Treatment with AIP also normalized the higher frequency of NMDAR-mediated miniature EPSCs of PVN neurons in SHRs. CaMKII-mediated phosphorylation level of GluN2B serine 1303 (S1303) in the PVN, but not in the hippocampus and frontal cortex, was significantly higher in SHRs than in WKY rats. Lowering blood pressure with celiac ganglionectomy in SHRs did not alter the increased level of phosphorylated GluN2B S1303 in the PVN. In addition, microinjection of AIP into the PVN significantly reduced arterial blood pressure and lumbar sympathetic nerve discharges in SHRs. Our findings suggest that CaMKII activity is increased in the PVN and contributes to potentiated presynaptic and postsynaptic NMDAR activity to elevate sympathetic vasomotor tone in hypertension. SIGNIFICANCE STATEMENT Heightened sympathetic vasomotor tone is a major contributor to the development of hypertension. Although glutamate NMDA receptor (NMDAR)-mediated excitatory drive in the hypothalamus plays a critical role in increased sympathetic output in hypertension, the molecular mechanism involved in potentiated NMDAR activity of hypothalamic presympathetic neurons remains unclear. Here we show that the activity of calcium/calmodulin-dependent protein kinase II (CaMKII) is increased and plays a key role in the potentiated presynaptic and postsynaptic NMDAR activity of hypothalamic presympathetic neurons in hypertension. Also, the inhibition of CaMKII in the hypothalamus reduces elevated blood pressure and sympathetic nerve discharges in hypertension. This new knowledge extends our understanding of the mechanism of synaptic plasticity in the hypothalamus and suggests new strategies to treat neurogenic hypertension. Copyright © 2017 the authors 0270-6474/17/3710690-10$15.00/0.

Psychometric properties of the Chinese version of the Menopause-Specific Quality-of-Life questionnaire

PubMed Central

Nie, Guangning; Yang, Hongyan; Liu, Jian; Zhao, ChunMei; Wang, Xiaoyun

2017-01-01

Abstract Objective: The Menopause-Specific Quality-of-Life (MENQOL) questionnaire was developed as a specific tool to measure the health-related quality-of-life of postmenopausal women. Thus far, the Chinese version questionnaire has not been subjected to psychometric assessment with a large sample. This study aims to evaluate the validity and reliability of the Chinese version of the MENQOL specific to postmenopausal women in China. Methods: A total of 1,137 menopausal symptomatic and 491 menopausal asymptomatic women from eight cities in China were recruited using a convenience sampling method. Psychometric properties were evaluated by descriptive statistics, validity, and reliability. Reliability was assessed for each subscale of the MENQOL through internal consistency reliability with Cronbach's α and intersubscale correlations. Item-domain correlations, principal components analysis (PCA), and confirmatory factor analysis were performed to determine construct validity. t tests were used to compare the differences between the menopausal symptomatic and asymptomatic women and to evaluate the discriminate validity. Pearson correlation coefficients were calculated between MENQOL scores and the Kupperman index to assess criterion-related validity. Results: The most common symptoms in Chinese menopausal symptomatic women were “experiencing poor memory” (94.4%), “feeling tired or worn out” (93.8%), “aching in muscle and joints” (89.4%), “low backache” (86.9%), “decrease in physical strength” (86.6%), “aches in back of neck or head” (86.2%), “difficulty sleeping” (83.6%), “accomplishing less than I used to” (83.4%), “feeling a lack of energy” (83.3%), “change in your sexual desire” (81%), and “hot flash” (80.7%) among others. The symptoms of “increased facial hair” were rarely seen (9.9%). The vasomotor domain, as well as psychosocial, physical, and sexual domains showed high reliability (Cronbach's α 0.84, 0.87, 0.89, and 0.86, respectively). Item-domain correlation analysis showed that all items correlated more strongly with their own domains than with other domains. In the PCA, after deleting the “increased facial hair” item, items in the vasomotor, sexual, and psychosocial subscales loaded on their respective domains by and large, and items in the physical subscale divided into two factors. The PCA revealed a latent structure of the Chinese version of MENQOL nearly identical to the original MENQOL domains. The confirmatory factor analysis demonstrated that the questionnaire fits well with a four-domain model. The MENQOL can discriminate between menopausal symptomatic women with asymptomatic women as it showed good discriminate validity. Criterion-related validity was confirmed by a significant correlation between MENQOL scores and the Kupperman index. Conclusions: This study showed that Chinese version of MENQOL has good psychometric properties and would be suitable to measure the health-related quality-of-life of Chinese menopausal women except for item 21 (increased facial hair). PMID:27922934

Pattern of clustering of menopausal problems: A study with a Bengali Hindu ethnic group.

PubMed

Dasgupta, Doyel; Pal, Baidyanath; Ray, Subha

2016-01-01

We attempted to find out how menopausal problems cluster with each other. The study was conducted among a group of women belonging to a Bengali-speaking Hindu ethnic group of West Bengal, a state located in Eastern India. We recruited 1,400 participants for the study. Information on sociodemographic aspects and menopausal problems were collected from these participants with the help of a pretested questionnaire. Results of cluster analysis showed that vasomotor, vaginal, and urinary problems cluster together, separately from physical and psychosomatic problems.

CEREBROSPINAL FLUID STASIS AND ITS CLINICAL SIGNIFICANCE

PubMed Central

Whedon, James M.; Glassey, Donald

2010-01-01

We hypothesize that stasis of the cerebrospinal fluid (CSF) occurs commonly and is detrimental to health. Physiologic factors affecting the normal circulation of CSF include cardiovascular, respiratory, and vasomotor influences. The CSF maintains the electrolytic environment of the central nervous system (CNS), influences systemic acid-base balance, serves as a medium for the supply of nutrients to neuronal and glial cells, functions as a lymphatic system for the CNS by removing the waste products of cellular metabolism, and transports hormones, neurotransmitters, releasing factors, and other neuropeptides throughout the CNS. Physiologic impedance or cessation of CSF flow may occur commonly in the absence of degenerative changes or pathology and may compromise the normal physiologic functions of the CSF. CSF appears to be particularly prone to stasis within the spinal canal. CSF stasis may be associated with adverse mechanical cord tension, vertebral subluxation syndrome, reduced cranial rhythmic impulse, and restricted respiratory function. Increased sympathetic tone, facilitated spinal segments, dural tension, and decreased CSF flow have been described as closely related aspects of an overall pattern of structural and energetic dysfunction in the axial skeleton and CNS. Therapies directed at affecting CSF flow include osteopathic care (especially cranial manipulation), craniosacral therapy, chiropractic adjustment of the spine and cranium, Network Care (formerly Network Chiropractic), massage therapy (including lymphatic drainage techniques), yoga, therapeutic breathwork, and cerebrospinal fluid technique. Further investigation into the nature and causation of CSF stasis, its potential effects upon human health, and effective therapies for its correction is warranted. PMID:19472865

Sympathetic nervous system and the kidney in hypertension.

PubMed

DiBona, Gerald F

2002-03-01

Long-term control of arterial pressure has been attributed to the kidney by virtue of its ability to couple the regulation of blood volume to the maintenance of sodium and water balance by the mechanisms of pressure natriuresis and diuresis. In the presence of a defect in renal excretory function, hypertension arises as the consequence of the need for an increase in arterial pressure to offset the abnormal pressure natriuresis and diuresis mechanisms, and to maintain sodium and water balance. There is growing evidence that an important cause of the defect in renal excretory function in hypertension is an increase in renal sympathetic nerve activity (RSNA). First, increased RSNA is found in animal models of hypertension and hypertensive humans. Second, renal denervation prevents or alleviates hypertension in virtually all animal models of hypertension. Finally, increased RSNA results in reduced renal excretory function by virtue of effects on the renal vasculature, the tubules, and the juxtaglomerular granular cells. The increase in RSNA is of central nervous system origin, with one of the stimuli being the action of angiotensin II, probably of central origin. By acting on brain stem nuclei that are important in the control of peripheral sympathetic vasomotor tone (e.g. rostral ventrolateral medulla), angiotensin II increases the basal level of RSNA and impairs its arterial baroreflex regulation. Therefore, the renal sympathetic nerves may serve as the link between central sympathetic nervous system regulatory sites and the kidney in contributing to the renal excretory defect in the development of hypertension.

Clinical Hypnosis in the Treatment of Post-Menopausal Hot Flashes: A Randomized Controlled Trial

PubMed Central

Elkins, Gary R.; Fisher, William I.; Johnson, Aimee K.; Carpenter, Janet S.; Keith, Timothy Z.

2012-01-01

Objective The use of estrogen and progesterone to manage vasomotor symptoms (i.e., hot flashes, night sweats) has declined due to concerns over their risks and there is an increased interest in alternate, effective, and low-risk treatments. This study reports the results of a randomized, controlled trial of clinical hypnosis in treating vasomotor symptoms among post-menopausal women. Methods Randomized, single-blind, controlled, clinical trial involving 187 post-menopausal women reporting a minimum of seven hot flashes per day, or at least 50 hot flashes a week at baseline between December 2008 and April 2012. Eligible participants received five weekly sessions of either clinical hypnosis or structured-attention control. Primary outcomes were hot flash frequency (subjectively and physiologically recorded) and hot flash score assessed by daily diaries at weeks 2–6, and 12. Secondary outcomes included measures of hot flash related daily interference, sleep quality and treatment satisfaction. Results In a modified intent-to-treat analysis that included all randomized participants that provided data, reported subjective hot flash frequency from baseline to week 12 showed a mean reduction of 55.82 hot flashes for the clinical hypnosis intervention (74.16%), versus a 12.89 hot flash reduction (17.13%) for the control (p<.001, 95% CI, 36.15–49.67). Mean reduction in hot flash score was 18.83 (80.32%) for the clinical hypnosis intervention as compared to 3.53 (15.38%) for the control (p<.001, 95% CI, 12.60–17.54). At 12 week follow-up, the mean reduction in physiologically monitored hot flashes was 5.92 (56.86%) for clinical hypnosis and .88 (9.94%) for the control (p<.001, 95% CI, 2.00–5.46). Secondary outcomes were significantly improved compared to control at 12 week follow-up in hot flash related interference (p<.001, 95% CI, 2.74–4.02), sleep quality (p<.001, 95% CI, 3.65–5.84), and treatment satisfaction (p<.001, 95% CI, 7.79–8.59). Conclusion Compared to a structured attention control, clinical hypnosis resulted in significant reductions in self-reported and physiologically measured hot flashes as well as hot flash scores in post-menopausal women. PMID:23435026

Feeling too hot or cold after breast cancer: Is it just a nuisance or a potentially important prognostic factor?

PubMed Central

KOKOLUS, KATHLEEN M.; HONG, CHI-CHEN; REPASKY, ELIZABETH A.

2010-01-01

There is widespread recognition among both patients and caregivers that breast cancer patients often experience debilitating deficiencies in their ability to achieve thermal comfort, feeling excessively hot or cold under circumstances when others are comfortable. However, this symptom receives little clinical or scientific attention beyond identification and testing of drugs that minimise menopausal-like symptoms. Could some of these symptoms represent an important prognostic signal? Could thermal discomfort be among other cytokine-driven sickness behaviour symptoms seen in many breast cancer patients? While the literature reveals a strong link between treatment for breast cancer and some menopausal vasomotor symptoms (e.g. hot flashes also known as “hot flushes”), there is little data on quantitative assessment of severity of different types of symptoms and their possible prognostic potential. However, recent, intriguing studies indicating a correlation between the presence of hot flashes and reduced development of breast cancer recurrence strongly suggests that more study on this topic is needed. In comparison to reports on the phenomenon of breast cancer-associated hot flashes, there is essentially no scientific study on the large number of women who report feeling excessively cold after breast cancer treatment. Since similar acquired thermal discomfort symptoms can occur in patients with cancers other than breast cancer, there may be as yet unidentified cancer – or treatment-driven factor related to temperature dysregulation. In general, there is surprisingly little information on the physiological relationship between body temperature regulation, vasomotor symptoms, and cancer growth and progression. The goal of this article is twofold: (1) to review the scientific literature egarding acquired deficits inthermoregulation among breast cancer survivors and (2) to propose some speculative ideas regarding the possible basis for thermal discomfort among some of these women. Specifically, we suggest a potential association with excessive proinflammatory cytokine activity, similar to other cytokine-driven symptoms experienced after breast cancer, including fatigue and depression. We highlight the similarity of some breast cancer-associated thermal discomfort symptoms to those which occur during fever, suggesting the possibility that there may be common underlying changes in pro-inflammatory cytokine activity in both conditions. We anticipate that this contribution will stimulate additional scientific interest among researchers in identifying potential mechanisms and prognostic significance of this under-studied aspect of breast cancer biology and survivorship. PMID:20849261

Comparative effects of inhaled diesel exhaust and ambient fine particles on inflammation, atherosclerosis, and vascular dysfunction

PubMed Central

Quan, Chunli; Sun, Qinghua; Lippmann, Morton; Chen, Lung-Chi

2011-01-01

Ambient air PM2.5 (particulate matter less than 2.5 μm in diameter) has been associated with cardiovascular diseases (CVDs), but the underlying mechanisms affecting CVDs are unknown. The authors investigated whether subchronic inhalation of concentrated ambient PM2.5 (CAPs), whole diesel exhaust (WDE), or diesel exhaust gases (DEGs) led to exacerbation of atherosclerosis, pulmonary and systemic inflammation, and vascular dysfunction; and whether DEG interactions with CAPs alter cardiovascular effects. ApoE−/− mice were simultaneously exposed via inhalation for 5 hours/day, 4 days/week, for up to 5 months to one of five different exposure atmospheres: (1) filtered air (FA); (2) CAPs (105 μg/m3); (3) WDE (DEP = 436 μg/m3); (4) DEG (equivalent to gas levels in WDE group); and (5) CAPs+DEG (PM2.5: 113 μg/m3; with DEG equivalent to WDE group). After 3 and 5 months, lung lavage fluid and blood sera were analyzed, and atherosclerotic plaques were quantified by ultrasound imaging, hematoxylin and eosin (H&E stain), and en face Sudan IV stain. Vascular functions were assessed after 5 months of exposure. The authors showed that (1) subchronic CAPs, WDE, and DEG inhalations increased serum vascular cell adhesion molecule (VCAM)-1 levels and enhanced phenylephrine (PE)-induced vasoconstriction; (2) for plaque exacerbation, CAPs > WDE > DEG = FA, thus PM components (not present in WDE) were responsible for plaque development; (3) atherosclerosis can exacerbated through mechanistic pathways other than inflammation and vascular dysfunction; and (4) although there were no significant interactions between CAPs and DEG on plaque exacerbation, it is less clear whether the effects of CAPs on vasomotor dysfunction and pulmonary/systemic inflammation were enhanced by the DEG coexposure. PMID:20462391

Apixaban Enhances Vasodilatation Mediated by Protease-Activated Receptor 2 in Isolated Rat Arteries

PubMed Central

Villari, Ambra; Giurdanella, Giovanni; Bucolo, Claudio; Drago, Filippo; Salomone, Salvatore

2017-01-01

Apixaban (APX) is a direct inhibitor of factor X (FXa) approved for prophylaxis and treatment of deep venous thrombosis and atrial fibrillation. Because FXa activates protease-activated receptor 2 (PAR-2) in endothelium and vascular smooth muscle, inhibition of FXa by APX may affect vasomotor function. The effect of APX was assessed in vitro, by wire myography, in rat mesenteric resistance arteries (MRAs) and basilar arteries challenged with vasoconstrictors [phenylephrine (PE); 5-hydroxytryptamine (5-HT)], vasodilators [acetylcholine (ACh); sodium nitroprusside (SNP)] or with the PAR-2 peptide agonist SLIGRL. APX (10 μM) reduced the vasoconstriction to PE and 5-HT while did not change the vasodilatation to ACh or SNP. SLIGRL induced concentration-dependent vasodilation in pre-constricted arteries, that was reduced by incubation with the NO inhibitor NG-nitro-L-arginine (L-NNA) and abolished by endothelium removal. APX enhanced vasodilation to SLIGRL either in the presence or in the absence of L-NNA, but was ineffective in endothelium-denuded vessels. In preparations from heparin-treated rats (to inhibit FXa) APX did not change the vasodilation to SLIGRL. FXa enzymatic activity, detected in mesentery homogenates from controls, was inhibited by APX, whereas APX-sensitive enzymatic activity was undetectable in homogenates from heparin-treated rats. Immunoblot analysis showed that incubation of MRA or aorta with APX increased the abundance of PAR-2, an effect not seen in MRA from heparin-treated rats or in endothelium-denuded aortas. In conclusion, inhibition of FXa by APX increases vasodilatation mediated by PAR-2. APX may act by inhibiting PAR-2 desensitization induced by endogenous FXa. This effect could be useful in the context of endothelial dysfunction associated to cardiovascular diseases. PMID:28769809

Anxiogenic CO2 Stimulus Elicits Exacerbated Hot Flash-like Responses in a Rat Menopause Model and Hot Flashes in Menopausal Women

PubMed Central

Federici, Lauren M.; Roth, Sarah Dorsey; Krier, Connie; Fitz, Stephanie D.; Skaar, Todd; Shekhar, Anantha; Carpenter, Janet S.; Johnson, Philip L.

2016-01-01

Objective Since longitudinal studies determined that anxiety is a strong risk factor for hot flashes, we hypothesized that an anxiogenic stimulus that signals air hunger (hypercapnic, normoxic gas) would trigger an exacerbated hot flash-associated increase in tail skin temperature (TST) in a rat ovariectomy (OVEX) model of surgical menopause and hot flashes in symptomatic menopausal women. We also assessed TST responses in OVEX serotonin transporter (SERT)+/− rats that models a common polymorphism that is associated with increased climacteric symptoms in menopausal women and increases in anxiety traits. Methods OVEX and sham-OVEX rats (initial experiment) and wildtype and SERT+/− OVEX rats (subsequent experiment) were exposed to a 5 min infusion of 20%CO2 normoxic gas while measuring TST. Menopausal women were given brief 20% and 35%CO2 challenges, and hot flashes were self-reported and objectively verified. Results Compared to controls, OVEX rats had exacerbated increases in TST, and SERT+/− OVEX rats had prolonged TST increases following CO2. Most women reported mild/moderate hot flashes after CO2 challenges, and the hot flash severity to CO2 was positively correlated with daily hot flash frequency. Conclusions The studies demonstrate that this anxiogenic stimulus is capable of inducing cutaneous vasomotor responses in OVEX rats, and eliciting hot flashes in menopausal women. In rats, the severity of the response was mediated by loss of ovarian function and increased anxiety traits (SERT+/−), and, in women, by daily hot flash frequency. These findings may provide insights into anxiety related triggers and genetic risk factors for hot flashes in thermoneutral environments. PMID:27465717

Scaffold-Free Tubular Tissues Created by a Bio-3D Printer Undergo Remodeling and Endothelialization when Implanted in Rat Aortae

PubMed Central

Itoh, Manabu; Nakayama, Koichi; Noguchi, Ryo; Kamohara, Keiji; Furukawa, Kojirou; Uchihashi, Kazuyoshi; Toda, Shuji; Oyama, Jun-ichi; Node, Koichi; Morita, Shigeki

2015-01-01

Background Small caliber vascular prostheses are not clinically available because synthetic vascular prostheses lack endothelial cells which modulate platelet activation, leukocyte adhesion, thrombosis, and the regulation of vasomotor tone by the production of vasoactive substances. We developed a novel method to create scaffold-free tubular tissue from multicellular spheroids (MCS) using a “Bio-3D printer”-based system. This system enables the creation of pre-designed three-dimensional structures using a computer controlled robotics system. With this system, we created a tubular structure and studied its biological features. Methods and Results Using a “Bio-3D printer,” we made scaffold-free tubular tissues (inner diameter of 1.5 mm) from a total of 500 MCSs (2.5× 104 cells per one MCS) composed of human umbilical vein endothelial cells (40%), human aortic smooth muscle cells (10%), and normal human dermal fibroblasts (50%). The tubular tissues were cultured in a perfusion system and implanted into the abdominal aortas of F344 nude rats. We assessed the flow by ultrasonography and performed histological examinations on the second (n = 5) and fifth (n = 5) day after implantation. All grafts were patent and remodeling of the tubular tissues (enlargement of the lumen area and thinning of the wall) was observed. A layer of endothelial cells was confirmed five days after implantation. Conclusions The scaffold-free tubular tissues made of MCS using a Bio-3D printer underwent remodeling and endothelialization. Further studies are warranted to elucidate the underlying mechanism of endothelialization and its function, as well as the long-term results. PMID:26325298

Carboxyhemoglobin levels in umbilical cord blood of women with pre-eclampsia and intrauterine growth restriction.

PubMed

Yusuf, Kamran; Kamaluddeen, Majeeda; Wilson, R Douglas; Akierman, Albert

2012-11-01

Pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are associated with abnormal placentation. Heme oxygenase (HO) and carbon monoxide (CO) are involved in normal placental development and function and vasomotor control in the placenta. The objective of our study was to measure CO levels, as assessed by carboxyhemoglobin (COHb) levels in the umbilical cord arterial blood of women with PE, normotensive IUGR (<10th percentile for birth weight), and normotensive pregnancies with appropriate-for-gestational age (AGA) infants. We prospectively analyzed COHb levels in the umbilical arterial blood of women with PE, normotensive IUGR, and normotensive AGA pregnancies. Exclusion criteria included cigarette smoke exposure, hemolytic disorders, a positive direct anti-globulin test, chronic hypertension, fever, and any significant medical illness. COHb levels were measured using the ABL 725 blood gas analyzer. There were 41 women in the normotensive AGA group, 42 in the PE group, and 36 in the normotensive IUGR group. Maternal age, mode of delivery, gravidity, parity, and gender of the infants were similar in the three groups. Gestational age and birth weight were significantly higher in the normotensive AGA group compared with the other two groups. COHb levels were significantly lower in the PE group compared with the normotensive AGA group (0.38±0.06% vs. 0.77±0.11%, P<0.05). COHb levels, although lower in the normotensive IUGR group compared with the normotensive AGA group, did not reach statistical significance. Our data suggests the HO-CO system may have a role in the pathogenesis of PE. We also, for the first time, provide information on umbilical arterial COHb levels in normotensive IUGR pregnancies.

System properties, feedback control and effector coordination of human temperature regulation.

PubMed

Werner, Jürgen

2010-05-01

The aim of human temperature regulation is to protect body processes by establishing a relative constancy of deep body temperature (regulated variable), in spite of external and internal influences on it. This is basically achieved by a distributed multi-sensor, multi-processor, multi-effector proportional feedback control system. The paper explains why proportional control implies inherent deviations of the regulated variable from the value in the thermoneutral zone. The concept of feedback of the thermal state of the body, conveniently represented by a high-weighted core temperature (T (c)) and low-weighted peripheral temperatures (T (s)) is equivalent to the control concept of "auxiliary feedback control", using a main (regulated) variable (T (c)), supported by an auxiliary variable (T (s)). This concept implies neither regulation of T (s) nor feedforward control. Steady-states result in the closed control-loop, when the open-loop properties of the (heat transfer) process are compatible with those of the thermoregulatory processors. They are called operating points or balance points and are achieved due to the inherent property of dynamical stability of the thermoregulatory feedback loop. No set-point and no comparison of signals (e.g. actual-set value) are necessary. Metabolic heat production and sweat production, though receiving the same information about the thermal state of the body, are independent effectors with different thresholds and gains. Coordination between one of these effectors and the vasomotor effector is achieved by the fact that changes in the (heat transfer) process evoked by vasomotor control are taken into account by the metabolic/sweat processor.

Menopause related sleep disorders.

PubMed

Eichling, Philip S; Sahni, Jyotsna

2005-07-15

Sleep difficulty is one of the hallmarks of menopause. Following recent studies showing no cardiac benefit and increased breast cancer, the question of indications for hormonal therapy has become even more pertinent. Three sets of sleep disorders are associated with menopause: insomnia/depression, sleep disordered breathing and fibromyalgia. The primary predictor of disturbed sleep architecture is the presence of vasomotor symptoms. This subset of women has lower sleep efficiency and more sleep complaints. The same group is at higher risk of insomnia and depression. The "domino theory" of sleep disruption leading to insomnia followed by depression has the most scientific support. Estrogen itself may also have an antidepressant as well as a direct sleep effect. Treatment of insomnia in responsive individuals may be a major remaining indication for hormone therapy. Sleep disordered breathing (SDB) increases markedly at menopause for reasons that include both weight gain and unclear hormonal mechanisms. Due to the general under-recognition of SDB, health care providers should not assume sleep complaints are due to vasomotor related insomnia/depression without considering SDB. Fibromyalgia has gender, age and probably hormonal associations. Sleep complaints are almost universal in FM. There are associated polysomnogram (PSG) findings. FM patients have increased central nervous system levels of the nociceptive neuropeptide substance P (SP) and lower serotonin levels resulting in a lower pain threshold to normal stimuli. High SP and low serotonin have significant potential to affect sleep and mood. Treatment of sleep itself seems to improve, if not resolve FM. Menopausal sleep disruption can exacerbate other pre-existing sleep disorders including RLS and circadian disorders.

Partial cure achieved in a patient with near-complete cervical spinal cord injury (95% injury) after 3 years of coordination dynamics therapy.

PubMed

Schalow, G

2009-01-01

This report describes a case of a now 20-year-old young lady with a severe spinal cord injury (SCI) at cervical 5/6 levels (ASIA A), in whom a repair of some spinal cord functions could be achieved within 3 years of optimal coordination dynamics therapy (CDT). Magnetic Resonance Imaging (MRI) showed a destruction of almost 95% of the cross-sectional area at the injury levels. The 5% (if at all) spared cord tissue most likely consisted of only sensory tracts, since no motor functions were preserved below the level of injury. A near-complete recovery of the important vegetative functions urinary bladder control, respiration, and vasomotor tone could be achieved. Her motor and sensory functions also improved to some extent, and she is off all medications. However, her motor recovery was limited and she is still wheel-chair-dependent. There is functional and structural (MRI) evidence that the human spinal cord regenerates upon CDT. The movement-based learning therapy included the training of supported crawling, up-righting, walking, running, jumping, balance training, and exercising on special CDT devices. The regeneration of the spinal cord started after more than one year of CDT, it was very limited but continuous, and gave rise to substantial functional recovery. The recovery induced by regeneration upon CDT was quantified in terms of transient increases of coordination dynamics values, the improvement of motor programs as assessed by surface electromyography (sEMG), the improvement of movement performances, and the increase of the spinal cord matter at the injury site, quantified by MRI. The similarity between the improvement at cellular and integrative (network) level during this regeneration and development is analyzed with respect to 'walking'. Comparing the effort, required to achieve substantial improvement in this case of severe cervical SCI (with 95% cord destruction; 5% spared tissue) with the effort required in the case of partial cervical SCI (50% destruction; 50% spared tissue), IT is noted that the 95% injury is 10 times more intractable. It is inferred that in severe SCI, the repair crucially depends on the percentage of the spared tissue (tracts fibres and neuronal networks) at the injury site. Improper handling of the patient therefore, as false transport or too late relief of spinal cord compression, may give rise to further mechanical damage of the cord tissue for which a later administered intensive cCDT cannot compensate for.

[In vitro study over statins effects on cellular growth curves and its reversibility with mevalonate].

PubMed

Millan Núñez-Cortés, Jesús; Alvarez Rodriguez, Ysmael; Alvarez Novés, Granada; Recarte Garcia-Andrade, Carlos; Alvarez-Sala Walther, Luis

2014-01-01

HMG-CoA-Reductase inhibitors, also known as statins, are currently the most powerful cholesterol-lowering drugs available on the market. Clinical trials and experimental evidence suggest that statins have heavy anti-atherosclerotic effects. These are in part consequence of lipid lowering but also result from pleiotropic actions of the drugs. These so-called pleiotropic properties affect various aspects of cell function, inflammation, coagulation, and vasomotor activity. These effects are mediated either indirectly through LDL-c reduction or via a direct effect on cellular functions. Although many of the pleiotropic properties of statins may be a class effect, some may be unique to certain agents and account for differences in their pharmacological activity. So, although statins typically have similar effects on LDL-c levels, differences in chemical structure and pharmacokinetic profile can lead to variations in pleiotropic effects. In this paper we analize the in vitro effects of different statins over different cell lines from cells implicated in atherosclerotic process: endothelial cells, fibroblasts, and vascular muscular cells. In relation with our results we can proof that the effects of different dosis of different statins provides singular effects over growth curves of different cellular lines, a despite of a class-dependent effects. So, pleiotropic effects and its reversibility with mevalonate are different according with the molecule and the dosis. Copyright © 2013 Elsevier España, S.L. y SEA. All rights reserved.

Characterisation of a monoclonal antibody detecting Atlantic salmon endothelial and red blood cells, and its association with the infectious salmon anaemia virus cell receptor.

PubMed

Aamelfot, Maria; Weli, Simon C; Dale, Ole B; Koppang, Erling O; Falk, Knut

2013-05-01

Endothelial cells (ECs) line the luminal surfaces of the cardiovascular system and play an important role in cardiovascular functions such as regulation of haemostasis and vasomotor tone. A number of fish and mammalian viruses target these cells in the course of their infection. Infectious salmon anaemia virus (ISAV) attacks ECs and red blood cells (RBCs) of farmed Atlantic salmon (Salmo salar L.), producing the severe disease of infectious salmon anaemia (ISA). The investigation of ISA has up to now been hampered by the lack of a functional marker for ECs in Atlantic salmon in situ. In this study, we report the characterisation and use of a novel monoclonal antibody (MAb) detecting Atlantic salmon ECs (e.g. vessel endothelium, endocardial cells and scavenger ECs) and RBCs. The antibody can be used with immunohistochemistry, IFAT and on Western blots. It appears that the epitope recognised by the antibody is associated with the ISAV cellular receptor. Besides being a tool to identify ECs in situ, it could be useful in further studies of the pathogenicity of ISA. Finally, the detection of an epitope shared by ECs and RBCs agrees with recent findings that these cells share a common origin, thus the MAb can potentially be used to study the ontogeny of these cells in Atlantic salmon. © 2013 Anatomical Society.

ATP: a vasoactive signal in the pericyte-containing microvasculature of the rat retina

PubMed Central

Kawamura, Hajime; Sugiyama, Tetsuya; Wu, David M; Kobayashi, Masato; Yamanishi, Shigeki; Katsumura, Kozo; Puro, Donald G

2003-01-01

In this study we tested the hypothesis that extracellular ATP regulates the function of the pericyte-containing retinal microvessels. Pericytes, which are more numerous in the retina than in any other tissue, are abluminally located cells that may adjust capillary perfusion by contracting and relaxing. At present, knowledge of the vasoactive molecules that regulate pericyte function is limited. Here, we focused on the actions of extracellular ATP because this nucleotide is a putative glial-to-vascular signal, as well as being a substance released by activated platelets and injured cells. In microvessels freshly isolated from the adult rat retina, we monitored ionic currents via perforated-patch pipettes, measured intracellular calcium levels with the use of fura-2, and visualized microvascular contractions with the aid of time-lapse photography. We found that ATP induced depolarizing changes in the ionic currents, increased calcium levels and caused pericytes to contract. P2X7 receptors and UTP-activated receptors mediated these effects. Consistent with ATP serving as a vasoconstrictor for the pericyte-containing microvasculature of the retina, the microvascular lumen narrowed when an adjacent pericyte contracted. In addition, the sustained activation of P2X7 receptors inhibited cell-to-cell electrotonic transmission within the microvascular networks. Thus, ATP not only affects the contractility of individual pericytes, but also appears to regulate the spatial and temporal dynamics of the vasomotor response. PMID:12876212

Vocational rehabilitation considerations for people with reflex sympathetic dystrophy.

PubMed

Smith, T S; Genoff, M C

1997-01-01

Reflex sympathetic dystrophy (RSD) is identified by the existence of pain, trophic changes, vasomotor instability, limited range of motion and swelling of an extremity. RSD is difficult to treat and prognosis is often poor. Although widely noted in the medical literature, the vocational rehabilitation literature has failed to address the potential role of vocational rehabilitation professionals in the social and economic employment outcome for people with RSD. Vocational rehabilitation professionals are defined as those performing vocational assessments, assessing transferable skills, determining adaptive skills, certifying residual work-related capacities, conducting vocational interest testing, coordinating efforts with pre-injury employers to assist in work reentry efforts, or performing other activities to assist in the placement or retraining of individuals with RSD. The sources used for this article include a review of the literature and observations of the authors. A vocational rehabilitation primer is provided. The following topics are addressed: the anatomical and physiological basis of RSD, treatment protocols, difficulties in accurately diagnosing RSD, influence of litigation, job placement considerations and vocational planning. As the vocational rehabilitation counsellor faces a greater number of people either diagnosed with RSD, or exhibiting RSD symptoms, he/she will be challenged to: (1) increase one's knowledge base about the etiology and treatment of RSD; (2) coordinate personal efforts with other professionals; and (3) provide personal counselling to address lifestyle and motivational factors.

Complementary and Alternative Approaches to Menopause.

PubMed

Taylor, Maida

2015-09-01

Given the persistent confusion about the risks and benefits of hormone therapy since 2002 and the first publication from the Women's Health Initiative's primary findings, women and health care providers are increasingly motivated to find effective, nonhormonal approaches to treat menopause-related symptoms. Complementary and alternative medicine has grown increasingly popular in the last decade. A wide array of botanic medicines is offered as an alternative approach to hormone therapy for menopause, but data documenting efficacy and safety are limited. None of the available botanicals is as effective as hormone therapy in the management of vasomotor symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

Transcranial Doppler: Techniques and advanced applications: Part 2

PubMed Central

Sharma, Arvind K.; Bathala, Lokesh; Batra, Amit; Mehndiratta, Man Mohan; Sharma, Vijay K.

2016-01-01

Transcranial Doppler (TCD) is the only diagnostic tool that can provide continuous information about cerebral hemodynamics in real time and over extended periods. In the previous paper (Part 1), we have already presented the basic ultrasound physics pertaining to TCD, insonation methods, and various flow patterns. This article describes various advanced applications of TCD such as detection of right-to-left shunt, emboli monitoring, vasomotor reactivity (VMR), monitoring of vasospasm in subarachnoid hemorrhage (SAH), monitoring of intracranial pressure, its role in stoke prevention in sickle cell disease, and as a supplementary test for confirmation of brain death. PMID:27011639

Developmental Programming of Renal Function and Re-Programming Approaches.

PubMed

Nüsken, Eva; Dötsch, Jörg; Weber, Lutz T; Nüsken, Kai-Dietrich

2018-01-01

Chronic kidney disease affects more than 10% of the population. Programming studies have examined the interrelationship between environmental factors in early life and differences in morbidity and mortality between individuals. A number of important principles has been identified, namely permanent structural modifications of organs and cells, long-lasting adjustments of endocrine regulatory circuits, as well as altered gene transcription. Risk factors include intrauterine deficiencies by disturbed placental function or maternal malnutrition, prematurity, intrauterine and postnatal stress, intrauterine and postnatal overnutrition, as well as dietary dysbalances in postnatal life. This mini-review discusses critical developmental periods and long-term sequelae of renal programming in humans and presents studies examining the underlying mechanisms as well as interventional approaches to "re-program" renal susceptibility toward disease. Clinical manifestations of programmed kidney disease include arterial hypertension, proteinuria, aggravation of inflammatory glomerular disease, and loss of kidney function. Nephron number, regulation of the renin-angiotensin-aldosterone system, renal sodium transport, vasomotor and endothelial function, myogenic response, and tubuloglomerular feedback have been identified as being vulnerable to environmental factors. Oxidative stress levels, metabolic pathways, including insulin, leptin, steroids, and arachidonic acid, DNA methylation, and histone configuration may be significantly altered by adverse environmental conditions. Studies on re-programming interventions focused on dietary or anti-oxidative approaches so far. Further studies that broaden our understanding of renal programming mechanisms are needed to ultimately develop preventive strategies. Targeted re-programming interventions in animal models focusing on known mechanisms will contribute to new concepts which finally will have to be translated to human application. Early nutritional concepts with specific modifications in macro- or micronutrients are among the most promising approaches to improve future renal health.

Developmental Programming of Renal Function and Re-Programming Approaches

PubMed Central

Nüsken, Eva; Dötsch, Jörg; Weber, Lutz T.; Nüsken, Kai-Dietrich

2018-01-01

Chronic kidney disease affects more than 10% of the population. Programming studies have examined the interrelationship between environmental factors in early life and differences in morbidity and mortality between individuals. A number of important principles has been identified, namely permanent structural modifications of organs and cells, long-lasting adjustments of endocrine regulatory circuits, as well as altered gene transcription. Risk factors include intrauterine deficiencies by disturbed placental function or maternal malnutrition, prematurity, intrauterine and postnatal stress, intrauterine and postnatal overnutrition, as well as dietary dysbalances in postnatal life. This mini-review discusses critical developmental periods and long-term sequelae of renal programming in humans and presents studies examining the underlying mechanisms as well as interventional approaches to “re-program” renal susceptibility toward disease. Clinical manifestations of programmed kidney disease include arterial hypertension, proteinuria, aggravation of inflammatory glomerular disease, and loss of kidney function. Nephron number, regulation of the renin–angiotensin–aldosterone system, renal sodium transport, vasomotor and endothelial function, myogenic response, and tubuloglomerular feedback have been identified as being vulnerable to environmental factors. Oxidative stress levels, metabolic pathways, including insulin, leptin, steroids, and arachidonic acid, DNA methylation, and histone configuration may be significantly altered by adverse environmental conditions. Studies on re-programming interventions focused on dietary or anti-oxidative approaches so far. Further studies that broaden our understanding of renal programming mechanisms are needed to ultimately develop preventive strategies. Targeted re-programming interventions in animal models focusing on known mechanisms will contribute to new concepts which finally will have to be translated to human application. Early nutritional concepts with specific modifications in macro- or micronutrients are among the most promising approaches to improve future renal health. PMID:29535992

Endothelial safety of radiological contrast media: why being concerned.

PubMed

Scoditti, Egeria; Massaro, Marika; Montinari, Maria Rosa

2013-01-01

Iodinated radiocontrast media have been the most widely used pharmaceuticals for intravascular administration in diagnostic and interventional angiographic procedures. Although they are regarded as relatively safe drugs and vascular biocompatibility of contrast media has been progressively improved, severe adverse reactions may occur, among which acute nephropathy is one of the most clinically significant complications after intravascular administration of contrast media and a powerful predictor of poor early and long-term outcomes. Since radiocontrast media are given through the arterial or the venous circulation in vascular procedures, morphological and functional changes of the microvascular and macrovascular endothelial cells substantially contribute to the pathogenesis of organ-specific and systemic adverse reactions of contrast media. Endothelial toxicity of contrast media seems to be the result of both direct proapoptotic effects and morphological derangements, as well as endothelial dysfunction and induction of inflammation, oxidative stress, thrombosis, and altered vasomotor balance, with predominant vasoconstrictive response in atherosclerotic coronary arteries and kidney microcirculation. Further understanding of pathogenetic mechanisms underlying contrast media-induced adverse reactions in cellular targets, including endothelial cells, will hopefully lead to the development of novel preventive strategies appropriately curbing the pathogenesis of contrast media vasotoxicity. Copyright © 2012 Elsevier Inc. All rights reserved.

Microfluidic strategy to investigate dynamics of small blood vessel function

NASA Astrophysics Data System (ADS)

Yasotharan, Sanjesh; Bolz, Steffen-Sebastian; Guenther, Axel

2010-11-01

Resistance arteries (RAs, 30-300 microns in diameter) that are located within the terminal part of the vascular tree regulate the laminar perfusion of tissue with blood, via the peripheral vascular resistance, and hence controls the systemic blood pressure. The structure of RAs is adapted to actively controlling flow resistance by dynamically changing their diameter, which is non-linearly dependent on the temporal variation of the transmural pressure, perfusion flow rate and spatiotemporal changes in the chemical environment. Increases in systemic blood pressure (hypertension) resulting from pathologic changes in the RA response represent the primary risk factor for cardiovascular diseases. We use a microfluidic strategy to investigate small blood vessels by quantifying structural variations within the arterial wall, RA outer contour and diameter over time. First, we document the artery response to vasomotor drugs that were homogeneously applied at step-wise increasing concentration. Second, we investigate the response in the presence of well-defined axial and circumferential heterogeneities. Artery per- and superfusion is discussed based on microscale PIV measurements of the fluid velocity on both sides of the arterial wall. Structural changes in the arterial wall are quantified using cross-correlation and proper orthogonal decomposition analyses of bright-field micrographs.

Effects of hypoxia on the closing pressure of the canine systemic arterial circulation.

PubMed

Sylvester, J T; Gilbert, R D; Traystman, R J; Permutt, S

1981-10-01

We studied the relationships among closing pressure (Pc) and indices of systemic arterial resistance (Ra) and compliance (Ca) during hypoxic hypoxia (HH) and carbon monoxide hypoxia (COH) in anesthetized dogs with cardiac bypass and constant ventilation. Closing pressure was measured as the lowest level to which arterial pressure (Pa) fell after inflow to the arterial bed was reduced suddenly to zero. Since the fall of Pa to Pc could be well-described as a single exponential function of time and since Pc was always greater than outflow (venous) pressure. Ra and CA were determined by applying a "vascular waterfall" model to the arterial bed. During HH, Pc increased while Ra and Ca decreased. During COH, Pc and Ra decreased, but Ca did not change. The Pc results indicate that during HH, but not COH, a large portion of the systemic arterial bed experienced a marked increase in vasomotor tone, a qualitative difference that would have been missed if Pc had not been measured. The relationship among Pc, Ra, and Ca during hypoxia suggest these indices may have been determined largely by different portions of the arterial bed in which tone changed independently.

An emerging role for gasotransmitters in the control of breathing and ionic regulation in fish.

PubMed

Perry, Steve; Kumai, Y; Porteus, C S; Tzaneva, V; Kwong, R W M

2016-02-01

Three gases comprising nitric oxide, carbon monoxide and hydrogen sulphide, collectively are termed gasotransmitters. The gasotransmitters control several physiological functions in fish by acting as intracellular signaling molecules. Hydrogen sulphide, first implicated in vasomotor control in fish, plays a critical role in oxygen chemoreception owing to its production and downstream effects within the oxygen chemosensory cells, the neuroepithelial cells. Indeed, there is emerging evidence that hydrogen sulphide may contribute to oxygen sensing in both fish and mammals by promoting membrane depolarization of the chemosensory cells. Unlike hydrogen sulphide which stimulates breathing in zebrafish, carbon monoxide inhibits ventilation in goldfish and zebrafish whereas nitric oxide stimulates breathing in zebrafish larvae while inhibiting breathing in adults. Gasotransmitters also modulate ionic uptake in zebrafish. Though nothing is known about the role of CO, reduced activities of branchial Na(+)/K(+)-ATPase and H(+)-ATPase activities in the presence of NO donors suggest an inhibitory role of NO in fish osmoregulation. Hydrogen sulphide inhibits Na(+) uptake in zebrafish larvae and contributes to lowering Na(+) uptake capacity in fish acclimated to Na(+)-enriched water whereas it stimulates Ca(2+) uptake in larvae exposed to Ca(2+)-poor water.

[The phylogenetic theory of pathology. The arterial hypertension--a test of metabolic disorder. The biological basis of damage of target organs (a lecture)].

PubMed

Titov, V N

2013-05-01

The increase of blood tension is a diagnostic test of disorders of homeostasis, trophology, endoecology and adaptation in paracrine regulated coenosis of cells. This conditions results in disorder of microcirculation in the distal section of arterial race and in compensatory increase of blood tension in its proximal section. The increase of blood tension disturbs the function of paracrine coenosis of cells which have one's own system of hemo- and hydrodynamics such as brain with system of spinal liquor and kidneys with local pool of primary urine. They counteract the rise of blood tension and activate local, humoral system of renin-angiotensin-II increasing peripheral resistance to blood flow. At that, the compensatory blood tension becomes even higher. The aldosterone and natriuretic peptides are functional synergists. So, they preserve and excrete ions of Na+ and support the stability of unified pool of intercellular medium ("Inner Ocean" of organism) where all cells live. The parameters of this pool are limited most strictly in vivo. If at the level of nephron the conditions are formed that can alter the parameters of unified pool of intercellular medium the vasomotor center rises blood tension from the level of organism "forcing" nephrons to re-establish the parameters of this pool and normalize the biological functions and biological reactions. The blood pressure increase under pathology of kidneys is caused because of pathological compensation at the level of organism mediated by vegetal nervous system and dictated by necessity to preserve the parameters of inner medium of organism.

Responses to hyperthermia. Optimizing heat dissipation by convection and evaporation: Neural control of skin blood flow and sweating in humans.

PubMed

Smith, Caroline J; Johnson, John M

2016-04-01

Under normothermic, resting conditions, humans dissipate heat from the body at a rate approximately equal to heat production. Small discrepancies between heat production and heat elimination would, over time, lead to significant changes in heat storage and body temperature. When heat production or environmental temperature is high the challenge of maintaining heat balance is much greater. This matching of heat elimination with heat production is a function of the skin circulation facilitating heat transport to the body surface and sweating, enabling evaporative heat loss. These processes are manifestations of the autonomic control of cutaneous vasomotor and sudomotor functions and form the basis of this review. We focus on these systems in the responses to hyperthermia. In particular, the cutaneous vascular responses to heat stress and the current understanding of the neurovascular mechanisms involved. The available research regarding cutaneous active vasodilation and vasoconstriction is highlighted, with emphasis on active vasodilation as a major responder to heat stress. Involvement of the vasoconstrictor and active vasodilator controls of the skin circulation in the context of heat stress and nonthermoregulatory reflexes (blood pressure, exercise) are also considered. Autonomic involvement in the cutaneous vascular responses to direct heating and cooling of the skin are also discussed. We examine the autonomic control of sweating, including cholinergic and noncholinergic mechanisms, the local control of sweating, thermoregulatory and nonthermoregulatory reflex control and the possible relationship between sudomotor and cutaneous vasodilator function. Finally, we comment on the clinical relevance of these control schemes in conditions of autonomic dysfunction. Copyright © 2016 Elsevier B.V. All rights reserved.

Role of reactive oxygen and nitrogen species in the vascular responses to inflammation

PubMed Central

Kvietys, Peter R.; Granger, D. Neil

2012-01-01

Inflammation is a complex and potentially life-threatening condition that involves the participation of a variety of chemical mediators, signaling pathways, and cell types. The microcirculation, which is critical for the initiation and perpetuation of an inflammatory response, exhibits several characteristic functional and structural changes in response to inflammation. These include vasomotor dysfunction (impaired vessel dilation and constriction), the adhesion and transendothelial migration of leukocytes, endothelial barrier dysfunction (increased vascular permeability), blood vessel proliferation (angiogenesis), and enhanced thrombus formation. These diverse responses of the microvasculature largely reflect the endothelial cell dysfunction that accompanies inflammation and the central role of these cells in modulating processes as varied as blood flow regulation, angiogenesis, and thrombogenesis. The importance of endothelial cells in inflammation-induced vascular dysfunction is also predicated on the ability of these cells to produce and respond to reactive oxygen and nitrogen species. Inflammation seems to upset the balance between nitric oxide and superoxide within (and surrounding) endothelial cells, which is necessary for normal vessel function. This review is focused on defining the molecular targets in the vessel wall that interact with reactive oxygen species and nitric oxide to produce the characteristic functional and structural changes that occur in response to inflammation. This analysis of the literature is consistent with the view that reactive oxygen and nitrogen species contribute significantly to the diverse vascular responses in inflammation and supports efforts that are directed at targeting these highly reactive species to maintain normal vascular health in pathological conditions that are associated with acute or chronic inflammation. PMID:22154653

Cerebral Hemodynamics and Systemic Endothelial Function Are Already Impaired in Well-Controlled Type 2 Diabetic Patients, with Short-Term Disease

PubMed Central

Altavilla, Riccardo; Di Flaviani, Alessandra; Giordani, Ilaria; Malandrucco, Ilaria; Picconi, Fabiana; Passarelli, Francesco; Pasqualetti, Patrizio; Ercolani, Matilde; Vernieri, Fabrizio; Frontoni, Simona

2013-01-01

Objective Impaired cerebral vasomotor reactivity (VMR) and flow-mediated dilation (FMD) were found in selected subgroups of type 2 diabetes mellitus (T2DM) patients with long-term disease. Our study aimed to evaluate cerebral hemodynamics, systemic endothelial function and sympatho-vagal balance in a selected population of well-controlled T2DM patients with short-term disease and without cardiac autonomic neuropathy (CAN). Research Design and Methods Twenty-six T2DM patients with short-term (4.40±4.80 years) and well-controlled (HbA1C = 6.71±1.29%) disease, without any complications, treated with diet and/or metformin, were consecutively recruited. Eighteen controls, comparable by sex and age, were enrolled also. Results FMD and shear rate FMD were found to be reduced in T2DM subjects with short-term disease (8.5% SD 3.5 and 2.5 SD 1.3, respectively) compared to controls (15.4% SD 4.1 and 3.5 SD 1.4; p<.001 and p<.05). T2DM patients also displayed reduced VMR values than controls (39.4% SD 12.4 vs 51.7%, SD 15.5; p<.05). Sympatho-vagal balance was not different in T2DM patients compared to healthy subjects. FMD and shear rate FMD did not correlate with VMR in T2DM patients or in controls (p>.05). Conclusions In well-controlled T2DM patients with short-term disease cerebral hemodynamics and systemic endothelial function are altered while autonomic balance appeared to be preserved. PMID:24391751

Chaotic behavior of the coronary circulation.

PubMed

Trzeciakowski, Jerome; Chilian, William M

2008-05-01

The regulation of the coronary circulation is a complex paradigm in which many inputs that influence vasomotor tone have to be integrated to provide the coronary vasomotor adjustments to cardiac metabolism and to perfusion pressure. We hypothesized that the integration of many disparate signals that influence membrane potential of smooth muscle cells, calcium sensitivity of contractile filaments, receptor trafficking result in complex non-linear characteristics of coronary vasomotion. To test this hypothesis, we measured an index of vasomotion, flowmotion, the periodic fluctuations of flow that reflect dynamic changes in resistances in the microcirculation. Flowmotion was continuously measured in periods ranging from 15 to 40 min under baseline conditions, during antagonism of NO synthesis, and during combined purinergic and NOS antagonism in the beating heart of anesthetized open-chest dogs. Flowmotion was measured in arterioles ranging from 80 to 135 microm in diameter. The signals from the flowmotion measurements were used to derive quantitative indices of non-linear behavior: power spectra, chaotic attractors, correlation dimensions, and the sum of the Lyapunov exponents (Kolmogorov-Sinai entropy), which reflects the total chaos and unpredictability of flowmotion. Under basal conditions, the coronary circulation demonstrated chaotic non-linear behavior with a power spectra showing three principal frequencies in flowmotion. Blockade of nitric oxide synthase or antagonism of purinergic receptors did not affect the correlation dimensions, but significantly increased the Kolmogorov-Sinai entropy, altered the power spectra of flowmotion, and changed the nature of the chaotic attractor. These changes are consistent with the view that certain endogenous controls, nitric oxide and various purines (AMP, ADP, ATP, adenosine) make the coronary circulation more predictable, and that blockade of these controls makes the control of flow less predictable and more chaotic.

Associations of Menopausal Vasomotor Symptoms with Fracture Incidence

PubMed Central

Aragaki, Aaron; Cauley, Jane A.; Manson, JoAnn E.; LeBlanc, Erin; Wallace, Robert; Wactawski-Wende, Jean; LaCroix, Andrea; O'Sullivan, Mary Jo; Vitolins, Mara; Watts, Nelson B.

2015-01-01

Context: Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown. Objective: This study aimed to examine associations of baseline VMS with fracture incidence and BMD. Design: This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993–2005). Setting: Forty United States clinical centers. Participants: We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50–79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study. Interventions: None. Main Outcome Measures: We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9). Results: After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20–2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm2 lower femoral neck BMD (95% CI, −0.025–−0.005) and 0.016 g/cm2 lower lumbar spine BMD (95% CI, −0.032–−0.004). Conclusions: Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture. PMID:25522264

Extracellular HCO3- is sensed by mouse cerebral arteries: Regulation of tone by receptor protein tyrosine phosphatase γ

PubMed Central

Hansen, Kristoffer B; Boedtkjer, Donna MB; Aalkjaer, Christian; Boron, Walter F

2015-01-01

We investigate sensing and signaling mechanisms for H+, HCO3- and CO2 in basilar arteries using out-of-equilibrium solutions. Selectively varying pHo, [HCO3-]o, or pCO2, we find: (a) lowering pHo attenuates vasoconstriction and vascular smooth muscle cell (VSMC) Ca2+-responses whereas raising pHo augments vasoconstriction independently of VSMC [Ca2+]i, (b) lowering [HCO3-]o increases arterial agonist-sensitivity of tone development without affecting VSMC [Ca2+]i but c) no evidence that CO2 has direct net vasomotor effects. Receptor protein tyrosine phosphatase (RPTP)γ is transcribed in endothelial cells, and direct vasomotor effects of HCO3o- are absent in arteries from RPTPγ-knockout mice. At pHo 7.4, selective changes in [HCO3-]o or pCO2 have little effect on pHi. At pHo 7.1, decreased [HCO3-]o or increased pCO2 causes intracellular acidification, which attenuates vasoconstriction. Under equilibrated conditions, anti-contractile effects of CO2/HCO3- are endothelium-dependent and absent in arteries from RPTPγ-knockout mice. With CO2/HCO3- present, contractile responses to agonist-stimulation are potentiated in arteries from RPTPγ-knockout compared to wild-type mice, and this difference is larger for respiratory than metabolic acidosis. In conclusion, decreased pHo and pHi inhibit vasoconstriction, whereas decreased [HCO3-]o promotes vasoconstriction through RPTPγ-dependent changes in VSMC Ca2+-sensitivity. HCO3o- serves dual roles, providing substrate for pHi-regulating membrane transporters and modulating arterial responses to acid–base disturbances. PMID:26661205

Factors associated with poor sleep during menopause: results from the Midlife Women's Health Study.

PubMed

Smith, Rebecca L; Flaws, Jodi A; Mahoney, Megan M

2018-05-01

Poor sleep is one of the most common problems reported during menopause, and is known to vary throughout the menopause transition. The objective of this study was to describe the dynamics of poor sleep among participants of the Midlife Women's Health Study and to identify risk factors associated with poor sleep during the menopausal transition. Annual responses to surveys that included questions about the frequency of sleep disturbances and insomnia were analyzed to determine the likelihood of persistent poor sleep throughout the menopausal transition and the correlation of responses to the different sleep-related questions, including frequency of restless sleep during the first year of the study. Responses to questions about a large number of potential risk factors were used to identify risk factors for poor sleep. Poor sleep in premenopause was not predictive of poor sleep in perimenopause, and poor sleep in perimenopause was not predictive of poor sleep in postmenopause. Frequencies of each of the measures of poor sleep were highly correlated. For all sleep outcomes, high frequency of depression was related to a high frequency of poor sleep. Vasomotor symptoms were also significantly related with a higher frequency of all poor sleep outcomes. A history of smoking was also associated with higher frequencies of insomnia and sleep disturbances. The risk factors identified for poor sleep, depression and vasomotor symptoms, were consistently associated with poor sleep throughout the menopausal transition. The likelihood of these risk factors changed from premenopause, through perimenopause, and into postmenopause, however, which could explain changes in sleep difficulties across the menopausal transition. Treatment of these risk factors should be considered when addressing sleep difficulties in menopausal women. Copyright © 2018 Elsevier B.V. All rights reserved.

Cross-cultural study: experience, understanding of menopause, and related therapies in Australian and Laotian women.

PubMed

Sayakhot, Padaphet; Vincent, Amanda; Teede, Helena

2012-12-01

The aim of this study was to investigate and compare symptom experiences, beliefs, attitudes, and understanding of menopause and menopausal therapies in Australian and Laotian women. This was a cross-cultural, questionnaire-based study involving 108 women (56 Australian women and 52 Laotian women aged 40-65 y) attending outpatient clinics in Australia and Laos. Descriptive statistics and univariate analysis were conducted using Student's t test or Mann-Whitney U test, where appropriate. Psychological symptoms, depression, vasomotor symptoms, and sexual dysfunction were significantly higher in Australian women compared with Laotian women (P < 0.05). Australian women perceived the meaning of menopause as aging (57%), whereas most Laotian women reported not knowing what menopause meant to them (81%). Australian women's fears about menopause included weight gain (43%), aging (41%), and breast cancer (38%), whereas Laotian women reported not knowing about potential menopausal problems (85%). Exercise (55%), education and awareness (46%), and improving lifestyle (41%) were reported by Australian women as being effective in alleviating menopausal symptoms, with only 21% reporting not knowing what was effective compared with 83% of Laotian women. Many women reported not knowing the risks/benefits of hormonal therapies (50% of Australian women and 87% of Laotian women) and herbal therapies (79% of Australian women and 92% of Laotian women). General practitioners were the most common source of menopause information for both Australians (73%) and Laotians (67%). Sociocultural factors influence women's perception of menopause. Psychological symptoms, sexual dysfunction, and vasomotor symptoms are more commonly reported by Australian women than by Laotian women. Women have a limited understanding of the risks/benefits of menopausal therapies, and culturally appropriate education is needed.

Comparative study of the quality of life associated with menopause in Tunisia and France.

PubMed

Ferrand, Farida; Hajri, Selma; Benzineb, Sarah; Draoui, Dorra Mahfoudh; Hassoun, Danielle; Delanoë, Daniel; Zins, Marie; Ringa, Virginie

2013-06-01

Because the experience of menopause varies by ethnic group, society, and social class, we sought to compare quality of life (QoL) at menopause between Tunisian and French women. This secondary analysis of existing data collected in two independent, cross-sectional surveys (the French GAZEL cohort and a representative sample of Tunisian women) compared both samples for six dimensions of the Women's Health Questionnaire while taking into account social and demographic characteristics and menopause status with multivariate logistic models. Comparison of 1,040 Tunisian women aged 45 to 64 years with 774 French women aged 48 to 53 years showed that Tunisian women had a significantly lower QoL than the French women in every dimension (low QoL for Tunisian vs French, odds ratio [95% CI]: somatic symptoms, 2.1 [1.6-2.7]; depressed mood, 3.6 [2.8-4.7]; anxiety, 2.4 [1.8-3.3]; vasomotor symptoms, 1.7 [1.3-2.3]). QoL was also lower for working-class women, but associations were weaker than for country (low QoL for working class vs middle class, odds ratio [95% CI]: somatic symptoms: 1.9 [1.5-2.4]; depressed mood, 1.5 [1.2-1.8]; anxiety, 1.8 [1.5-2.3]; vasomotor symptoms, 1.7 [1.4-2.2]). Associations between country and QoL were stronger in the working class than in the middle class. This epidemiological study comparing France and a North African country sheds light on the major role of country of residence, social class, and their interaction in the experience of menopause. Levels of national wealth, human development, cultural constraints, and social and gender inequality are likely to explain how country and class affect QoL.

Sleep and menopause: a narrative review.

PubMed

Shaver, Joan L; Woods, Nancy F

2015-08-01

Our overall aim-through a narrative review-is to critically profile key extant evidence of menopause-related sleep, mostly from studies published in the last decade. We searched the database PubMed using selected Medical Subject Headings for sleep and menopause (n = 588 articles). Using similar headings, we also searched the Cochrane Library (n = 1), Embase (n = 449), Cumulative Index to Nursing and Allied Health Literature (n = 163), Web of Science (n = 506), and PsycINFO (n = 58). Articles deemed most related to the purpose were reviewed. Results were articulated with interpretive comments according to evidence of sleep quality (self-reported) and sleep patterns (polysomnography and actigraphy) impact as related to reproductive aging and in the context of vasomotor symptoms (VMS; self-reported), vasomotor activity (VMA) events (recorded skin conductance), depressed mood, and ovarian hormones. Predominantly, the menopausal transition conveys poor sleep beyond anticipated age effects. Perceptions of sleep are not necessarily translatable from detectable physical sleep changes and are probably affected by an emotional overlay on symptoms reporting. Sleep quality and pattern changes are mostly manifest in wakefulness indicators, but sleep pattern changes are not striking. Likely contributing are VMS of sufficient frequency/severity and bothersomeness, probably with a sweating component. VMA events influence physical sleep fragmentation but not necessarily extensive sleep loss or sleep architecture changes. Lack of robust connections between perceived and recorded sleep (and VMA) could be influenced by inadequate detection. There is a need for studies of women in well-defined menopausal transition stages who have no sleep problems, accounting for sleep-related disorders, mood, and other symptoms, with attention to VMS dimensions, distribution of VMS during night and day, and advanced measurement of symptoms and physiologic manifestations.

Evaluation of the measurement model and clinically important differences for menopause-specific quality of life associated with bazedoxifene/conjugated estrogens.

PubMed

Bushmakin, Andrew G; Abraham, Lucy; Pinkerton, JoAnn V; Cappelleri, Joseph C; Mirkin, Sebastian

2014-08-01

This study aims to confirm the factor structure of the Menopause-Specific Quality of Life (MENQOL) questionnaire by using confirmatory factor analysis (CFA) and to determine whether improvements in menopause-specific health-related quality of life (HRQOL) observed with bazedoxifene (BZA)/conjugated estrogens (CE) relative to placebo are clinically meaningful. Postmenopausal women with seven or more moderate to severe hot flushes per day (or ≥50 per wk) received BZA 20 mg/CE 0.45 mg, BZA 20 mg/CE 0.625 mg, or placebo for 12 weeks. HRQOL and treatment satisfaction were evaluated using the MENQOL questionnaire and the Menopause Symptoms Treatment Satisfaction Questionnaire, respectively. The structure of the MENQOL questionnaire was evaluated using CFA. To estimate clinically important differences (CIDs) in HRQOL, we used a repeated-measures model to estimate changes in MENQOL domain and total scores using Menopause Symptoms Treatment Satisfaction Questionnaire items as anchors. The CFA model fits the MENQOL data (Bentler's comparative fit index >0.9). CID estimates ranged from 0.5 to 1.2 for the MENQOL domains and total score. Change from baseline in MENQOL vasomotor domain score for BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg compared with placebo was greater than the estimated CID, as were changes in MENQOL physical domain and total scores for BZA 20 mg/CE 0.625 mg compared with placebo. CFA confirms the factor structure of the MENQOL questionnaire. Treatment with BZA/CE provides clinically meaningful improvements in HRQOL in a population of postmenopausal women with bothersome vasomotor symptoms.

Truths, errors, and lies around "reflex sympathetic dystrophy" and "complex regional pain syndrome".

PubMed

Ochoa, J L

1999-10-01

The shifting paradigm of reflex sympathetic dystrophy-sympathetically maintained pains-complex regional pain syndrome is characterized by vestigial truths and understandable errors, but also unjustifiable lies. It is true that patients with organically based neuropathic pain harbor unquestionable and physiologically demonstrable evidence of nerve fiber dysfunction leading to a predictable clinical profile with stereotyped temporal evolution. In turn, patients with psychogenic pseudoneuropathy, sustained by conversion-somatization-malingering, not only lack physiological evidence of structural nerve fiber disease but display a characteristically atypical, half-subjective, psychophysical sensory-motor profile. The objective vasomotor signs may have any variety of neurogenic, vasogenic, and psychogenic origins. Neurological differential diagnosis of "neuropathic pain" versus pseudoneuropathy is straight forward provided that stringent requirements of neurological semeiology are not bypassed. Embarrassing conceptual errors explain the assumption that there exists a clinically relevant "sympathetically maintained pain" status. Errors include historical misinterpretation of vasomotor signs in symptomatic body parts, and misconstruing symptomatic relief after "diagnostic" sympathetic blocks, due to lack of consideration of the placebo effect which explains the outcome. It is a lie that sympatholysis may specifically cure patients with unqualified "reflex sympathetic dystrophy." This was already stated by the father of sympathectomy, René Leriche, more than half a century ago. As extrapolated from observations in animals with gross experimental nerve injury, adducing hypothetical, untestable, secondary central neuron sensitization to explain psychophysical sensory-motor complaints displayed by patients with blatantly absent nerve fiber injury, is not an error, but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies particularly when entrepreneurially inspired are condemnable and call for peer intervention.

Sex differences in the modulation of vasomotor sympathetic outflow during static handgrip exercise in healthy young humans

PubMed Central

Jarvis, Sara S.; VanGundy, Tiffany B.; Galbreath, M. Melyn; Shibata, Shigeki; Okazaki, Kazunobu; Reelick, Miriam F.; Levine, Benjamin D.

2011-01-01

Sex differences in sympathetic neural control during static exercise in humans are few and the findings are inconsistent. We hypothesized women would have an attenuated vasomotor sympathetic response to static exercise, which would be further reduced during the high sex hormone [midluteal (ML)] vs. the low hormone phase [early follicular (EF)]. We measured heart rate (HR), blood pressure (BP), and muscle sympathetic nerve activity (MSNA) in 11 women and 10 men during a cold pressor test (CPT) and static handgrip to fatigue with 2 min of postexercise circulatory arrest (PECA). HR increased during handgrip, reached its peak at fatigue, and was comparable between sexes. BP increased during handgrip and PECA where men had larger increases from baseline. Mean ± SD MSNA burst frequency (BF) during handgrip and PECA was lower in women (EF, P < 0.05), as was ΔMSNA-BF smaller (main effect, both P < 0.01). ΔTotal activity was higher in men at fatigue (EF: 632 ± 418 vs. ML: 598 ± 342 vs. men: 1,025 ± 416 a.u./min, P < 0.001 for EF and ML vs. men) and during PECA (EF: 354 ± 321 vs. ML: 341 ± 199 vs. men: 599 ± 327 a.u./min, P < 0.05 for EF and ML vs. men). During CPT, HR and MSNA responses were similar between sexes and hormone phases, confirming that central integration and the sympathetic efferent pathway was comparable between the sexes and across hormone phases. Women demonstrated a blunted metaboreflex, unaffected by sex hormones, which may be due to differences in muscle mass or fiber type and, therefore, metabolic stimulation of group IV afferents. PMID:21508291

Longitudinal Analysis of Changes in Weight and Waist Circumference in Relation to Incident Vasomotor Symptoms: the Study of Women’ Health Across the Nation (SWAN)

PubMed Central

Gold, Ellen B.; Crawford, Sybil L.; Shelton, Janie F.; Tepper, Ping G.; Crandall, Carolyn J.; Greendale, Gail A.; Matthews, Karen A.; Thurston, Rebecca C.; Avis, Nancy E.

2016-01-01

Objective Greater body mass index (BMI) and body fat are associated with vasomotor symptoms (VMS). Thus, weight loss may prevent VMS. We analyzed whether concurrent BMI or waist circumference and/or changes in weight or waist circumference predicted incident VMS and whether these relations differed by menopause stage or race/ethnicity. Methods Data from 10 follow-up visits for 1546 participants in the Study of Women's Health Across the Nation who reported no VMS at baseline were modeled for time to first symptomatic visit in relation to concurrent BMI and waist circumference and change in weight and waist circumference during early and late menopause using discrete survival analyses, adjusting for covariates. Results Greater concurrent BMI and waist circumference were significantly related to greater any and frequent (≥6 days in the last two weeks) incident VMS in early menopause and lower VMS risk in late menopause. Percentage weight change since baseline and since the prior visit were unrelated to incident any VMS in either menopause stage. Percentage weight change since baseline had a significant shallow U-shaped association with incident frequent VMS in early menopause (p=0.02), a shallow inverse U-shape in late menopause (p=0.02), and a significant interaction with menopause stage (p=0.004) but not with race/ethnicity. Recent weight change was unassociated with incident VMS in either menopause stage. Results were similar for waist change. Conclusions Concurrent BMI and waist circumference were positively related to incident VMS in early menopause and negatively related in late menopause. Maintaining healthy weight in early menopause may help prevent VMS. PMID:27749738

Longitudinal analysis of changes in weight and waist circumference in relation to incident vasomotor symptoms: the Study of Women's Health Across the Nation (SWAN).

PubMed

Gold, Ellen B; Crawford, Sybil L; Shelton, Janie F; Tepper, Ping G; Crandall, Carolyn J; Greendale, Gail A; Matthews, Karen A; Thurston, Rebecca C; Avis, Nancy E

2017-01-01

Greater body mass index (BMI) and body fat are associated with vasomotor symptoms (VMS). Thus, weight loss may prevent VMS. We analyzed whether concurrent BMI or waist circumference and/or changes in weight or waist circumference predicted incident VMS and whether these relations differed by menopause stage or race/ethnicity. Data from 10 follow-up visits for 1,546 participants in the Study of Women's Health Across the Nation who reported no VMS at baseline were modeled for time to first symptomatic visit in relation to concurrent BMI and waist circumference and change in weight and waist circumference during early and late menopause using discrete survival analyses, adjusting for covariates. Greater concurrent BMI and waist circumference were significantly related to greater any and frequent (≥6 d in the last 2 wk) incident VMS in early menopause and lower VMS risk in late menopause. Percentage weight change since baseline and since the prior visit was unrelated to incident any VMS in either menopause stage. Percentage weight change since baseline had a significant shallow U-shaped association with incident frequent VMS in early menopause (P = 0.02), a shallow inverse U-shape in late menopause (P = 0.02), and a significant interaction with menopause stage (P = 0.004) but not with race/ethnicity. Recent weight change was unassociated with incident VMS in either menopause stage. Results were similar for waist change. Concurrent BMI and waist circumference were positively related to incident VMS in early menopause and negatively related in late menopause. Maintaining healthy weight in early menopause may help prevent VMS.

Weather/temperature-sensitive vasomotor rhinitis may be refractory to intranasal corticosteroid treatment.

PubMed

Jacobs, Robert; Lieberman, Philip; Kent, Edward; Silvey, MaryJane; Locantore, Nicholas; Philpot, Edward E

2009-01-01

Vasomotor rhinitis (VMR) is a common but poorly understood disorder of which there are two major subgroups: VMR(w/t), triggered by weather/temperature and VMR(ir), triggered by airborne irritants. No specific biological pathways or specific treatments for VMR(w/t) or VMR(ir) have been identified. However, intranasal corticosteroids (INSs) are effective in treating many forms of nonallergic rhinitis that include these conditions. A recently introduced INS with established efficacy in allergic rhinitis and enhanced affinity, fluticasone furoate, may possess the potency and safety profile required to treat chronic VMR(w/t). Two replicate studies (FFR30006 and FFR30007) were conducted in six countries to evaluate the efficacy and safety of fluticasone furoate nasal spray in subjects with VMR(w/t). After a 7- to 14-day screening period, subjects (n = 699) with symptomatic VMR(w/t) received fluticasone furoate, 110 mug q.d. or placebo for 4 weeks in these two randomized, double-blind, parallel-group studies. Subjects rated their nasal symptoms (congestion, rhinorrhea, and postnasal drip) twice daily on a 4-point categorical scale and evaluated their overall response to treatment at study end. Fluticasone furoate did not significantly improve daily reflective total nasal symptom scores, the primary end point, versus placebo (p = 0.259) and there was no improvement in any other measure of efficacy. The active treatment was well tolerated. Fluticasone furoate was not effective in treating subjects with a newly defined condition, weather-sensitive VMR. These unexpected results suggest that VMR(w/t) is a distinct subgroup of VMR that is refractory to treatment with INSs. Additional study of other treatments for VMR(w/t) (including INSs) is warranted.

A Biphasic Change of Regional Blood Volume in the Frontal Cortex during Non-Rapid Eye Movement Sleep: A Near-Infrared Spectroscopy Study.

PubMed

Zhang, Zhongxing; Khatami, Ramin

2015-08-01

Current knowledge on hemodynamics in sleep is limited because available techniques do not allow continuous recordings and mainly focus on cerebral blood flow while neglecting other important parameters, such as blood volume (BV) and vasomotor activity. Observational study. Continuous measures of hemodynamics over the left forehead and biceps were performed using near-infrared spectroscopy (NIRS) during nocturnal polysomnography in 16 healthy participants in sleep laboratory. Temporal dynamics and mean values of cerebral and muscular oxygenated hemoglobin (HbO2), deoxygenated hemoglobin (HHb), and BV during different sleep stages were compared. A biphasic change of cerebral BV was observed which contrasted a monotonic increase of muscular BV during non-rapid eye movement sleep. A significant decrement in cerebral HbO2 and BV accompanied by an increase of HHb was recorded at sleep onset (Phase I). Prior to slow wave sleep (SWS) HbO2 and BV turned to increase whereas HHb began to decrease in subsequent Phase II suggested increased brain perfusion during SWS. The cerebral HbO2 slope correlated to BV slope in Phase I and II, but it only correlated to HHb slope in Phase II. The occurrence time of inflection points correlated to SWS latencies. Initial decrease of brain perfusion with decreased blood volume (BV) and oxygenated hemoglobin (HbO2) together with increasing muscular BV fit thermoregulation process at sleep onset. The uncorrelated and correlated slopes of HbO2 and deoxygenated hemoglobin indicate different mechanisms underlying the biphasic hemodynamic process in light sleep and slow wave sleep (SWS). In SWS, changes in vasomotor activity (i.e., increased vasodilatation) may mediate increasing cerebral and muscular BV. © 2015 Associated Professional Sleep Societies, LLC.

Sleep disturbance and correlates in menopausal women in Shanghai.

PubMed

Sun, Dongmei; Shao, Hongfang; Li, Changbin; Tao, Minfang

2014-03-01

The aim of this study was to investigate the sleep disturbance and its correlates in Chinese middle-aged women. A total of 2046 Chinese women 40-60 years of age were recruited in this cross-sectional descriptive study. The subjects were surveyed using the Pittsburgh Sleep Quality Index (PSQI), the modified Kupperman Index (KI), and a general questionnaire to obtain sociodemographic data. Data were analyzed using SPSS 20.0 software. In this study, the mean (standard deviation) age of the participants was 51.69 (6.54) years and the mean PSQI score was 6.88 (3.20). The prevalence of sleep disturbance was 33.2% (a PSQI global score ≥8). The prevalence of sleep disturbance was higher in women with a menopausal status (from 34.8% in premenopausal women to 40.9% in postmenopausal women, P < .001) and in women with an increased age (from 21.7% in women 40-44 years of age to 41.8% in women 55-60 years of age, P < .001). Vasomotor symptoms (classical menopausal symptoms, VMS) were associated with sleep disturbance. An increase in the severity of menopausal symptoms (higher total KI scores) was observed in women who experienced sleep disturbance. A logistic regression analysis revealed that menopausal status, vasomotor symptoms, modified KI scores, a history of disease, and older age (≥ 50 years) were significant risk factors for sleep disturbance. Sleep disturbance was highly prevalent in this large sample of middle-aged Chinese women. Therefore, clinicians should pay more attention to sleep problems in middle-aged Chinese women and measures should be taken to improve the quality of sleep in these women. Copyright © 2013 Elsevier Inc. All rights reserved.

Chronobiology and chronotherapy of allergic rhinitis and bronchial asthma.

PubMed

Smolensky, Michael H; Lemmer, Bjoern; Reinberg, Alain E

2007-08-31

Study of the chronobiology of allergic rhinitis (AR) and bronchial asthma (BA) and the chronopharmacology and chronotherapy of the medications used in their treatment began five decades ago. AR is an inflammatory disease of the upper airway tissue with hypersensitivity to specific environmental antigens, resulting in further local inflammation, vasomotor changes, and mucus hypersecretion. Symptoms include sneezing, nasal congestion, and runny and itchy nose. Approximately 25% of children and 40% of adults in USA are affected by AR during one or more seasons of the year. The manifestation and severity of AR symptoms exhibit prominent 24-h variation; in most persons they are worse overnight or early in the morning and often comprise nighttime sleep, resulting in poor daytime quality of life, compromised school and work performance, and irritability and moodiness. BA is also an inflammatory medical condition of the lower airways characterized by hypersensitivity to specific environmental antigens, resulting in greater local inflammation as well as bronchoconstriction, vasomotor change, and mucus hypersecretion. In USA an estimated 6.5 million children and 15.7 million adults have BA. The onset and worsening of BA are signaled by chest wheeze and/or croupy cough and difficult and labored breathing. Like AR, BA is primarily a nighttime medical condition. AR is treated with H1-antagonist, decongestant, and anti-inflammatory (glucocorticoid and leukotriene receptor antagonist and modifier) medications. Only H1-antagonist AR medications have been studied for their chronopharmacology and potential chronotherapy. BA is treated with some of the same medications and also theophylline and beta2-agonists. The chronopharmacology and chronotherapy of many classes of BA medications have been explored. This article reviews the rather extensive knowledge of the chronobiology of AR and BA and the chronopharmacology and chronotherapy of the various medications used in their treatment.

Is an unfavourable cardiovascular risk profile a risk factor for vasomotor menopausal symptoms? Results of a population-based cohort study.

PubMed

van den Berg, M J; Herber-Gast, G C M; van der Schouw, Y T

2015-08-01

Evidence suggests an association between vasomotor menopausal symptoms (VMSs), i.e. hot flushes and night sweats, and cardiovascular disease. However, the causal pathway is unclear. We investigated whether an unfavourable cardiovascular risk profile is a risk factor for VMS later in life. Retrospective cohort study. Women aged 50-70 from the general population. The Prospect-European Prospective Investigation into Cancer and Nutrition (Prospect-EPIC) cohort is a population-based cohort of women who enrolled between 1993 and 1997. Follow-up questionnaires were sent at 5-year intervals for 15 years. Women who returned the third questionnaire, answered questions regarding lifetime VMS and did not report VMS prior to baseline were included in this study (n = 1295). At baseline, the Framingham Risk Score (FRS) was determined. We used logistic regression analysis to calculate odds ratios (ORs) for the association between baseline FRS and incident VMS. Incident VMS. At baseline (mean age ± standard deviation, 52.2 ± 3.6 years), 21.2% had a FRS > 10%. During follow-up, 40.2% of women reported the onset of VMS. Adjusted for body mass index, physical activity, education and alcohol consumption, each point increase in FRS was associated with a decreased incidence of VMS [OR, 0.94 (95% CI, 0.91-0.97)]. Additional adjustment for menopausal status attenuated the OR to null [OR, 0.98 (95% CI, 0.95-1.01)]. None of the separate FRS variables were associated with VMS after adjustment for age. In our cohort, an unfavourable cardiovascular risk profile was not associated with VMS, and therefore we found no evidence for the involvement of a vascular mechanism in the etiology of VMS. © 2014 Royal College of Obstetricians and Gynaecologists.

Treatment of hyperplastic inferior nasal turbinates by means of a Ho:YAG laser

NASA Astrophysics Data System (ADS)

Sroka, Ronald; Leunig, Andreas; Janda, P.; Rosler, P.; Grevers, G.; Baumgartner, Reinhold

1999-06-01

Although the successful use of the Ho:YAG laser in nasal turbinate surgery had been reported no clinical study had been performed to assess the clinical outcome in longterm. By means of a pulsed Ho:YAG laser emitting at λ=2080nm (1J/pulse, 3-8 Hz) 57 patients suffering from nasal obstruction due to allergic rhinitis and vasomotoric rhinitis were treated under local anesthesia. The study was conducted by standardized questionnaire, photo documentation, allergy test, mucocilliar test, rhinomanometry, radiology and histology. Within 2 weeks after laser treatment a significant improvement of nasal airflow correlating to the extent of the ablated turbinate tissue could be determined. This effect lasted up until 1 year post treatment resulting in an improved quality of life in more than 80 percent of the patients. Side effects like nasal dryness and pain were rare (<4%), no immediate complications were observed. The total treatment time takes 3-8 min and nasal packing was not necessary after the laser procedure. In conclusion Ho:YAG laser treatment can be performed as an outpatient procedure under local anesthesia with excellent ablation of soft tissue in a short treatment time with promising results.

The isolated blood-perfused pig ear: an inexpensive and animal-saving model for skin penetration studies.

PubMed

de Lange, J; van Eck, P; Elliott, G R; de Kort, W L; Wolthuis, O L

1992-04-01

To overcome most of the disadvantages of current models to investigate percutaneous penetration of drugs or toxic substances, a model is proposed here based on the isolated pig ear, which is obtained at the slaughterhouse, and perfused with oxygenated blood from the same pig. To determine the viability of the preparations, we measured glucose consumption and lactate production as metabolic parameters, Na+ and K+ ions, as well as lactate dehydrogenase activity in blood as markers for cell damage, whereas vasomotor reactivity was assessed by administering noradrenaline and isoxsuprine. After 60 min of equilibration, only insignificant changes in these parameters were observed during the subsequent 3-hr test period (longer periods were not tested). A slight weight increase was noted during the total period 4 hr, presumably due to slight edema formation. On the basis of several types of measurements, such as in vivo blood flow and ear temperature and in vitro glucose metabolism, standard procedures were developed. It is concluded that this technique offers an easy to handle, cost-efficient, and animal-saving model for skin penetration studies that lacks most of the disadvantages of existing models.

Altered Nocturnal Cardiovascular Control in Children With Sleep-Disordered Breathing.

PubMed

El-Hamad, Fatima; Immanuel, Sarah; Liu, Xiao; Pamula, Yvonne; Kontos, Anna; Martin, James; Kennedy, Declan; Kohler, Mark; Porta, Alberto; Baumert, Mathias

2017-10-01

To assess cardiovascular control during sleep in children with sleep-disordered breathing (SDB) and the effect of adenotonsillectomy in comparison to healthy nonsnoring children. Cardiorespiratory signals obtained from overnight polysomnographic recordings of 28 children with SDB and 34 healthy nonsnoring children were analyzed. We employed an autoregressive closed-loop model with heart period (RR) and pulse transit time (PTT) as outputs and respiration as an external input to obtain estimates of respiratory gain and baroreflex gain. Mean and variability of PTT were increased in children with SDB across all stages of sleep. Low frequency power of RR and PTT were attenuated during non-rapid eye movement (REM) sleep. Baroreflex sensitivity was reduced in children with SDB in stage 2 sleep, while respiratory gain was increased in slow wave sleep. After adenotonsillectomy, these indices normalized in the SDB group attaining values comparable to those of healthy children. In children with mild-to-moderate SDB, vasomotor activity is increased and baroreflex sensitivity decreased during quiet, event-free non-REM sleep. Adenotonsillectomy appears to reverse this effect. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

The Effects of Inhaled Nickel Nanoparticles on Murine Endothelial Progenitor Cells

NASA Astrophysics Data System (ADS)

Liberda, Eric N.

Introduction. Particulate air pollution, specifically nickel found on or in particulate matter, has been associated with an increased risk of mortality in human population studies and can cause increases in vascular inflammation, generate reactive oxygen species, alter vasomotor tone, and potentiate atherosclerosis in murine exposures. With the discovery of endothelial progenitor cells (EPCs), a door has been opened which may explain these observed cardiovascular effects associated with inhaled air particles and nickel exposure. In order to further quantify the effects of inhaled nickel nanoparticles and attempt to elucidate how the observed findings from other studies may occur, several whole body inhalation exposure experiments to nickel nanoparticles were performed. Methods. Following whole body exposure to approximately 500mug/m3 of nickel nanoparticles for 5 hrs, bone marrow EPCs from C57BL/6 mice were isolated. EPCs were harvested for their RNA or used in a variety of assays including chemotaxis, tube formation, and proliferation. Gene expression was assessed for important receptors involved in EPC mobilization and homing using RT-PCR methods. EPCs, circulating endothelial progenitor cells, circulating endothelial cells (CECs), and endothelial microparticles (EMPs) were quantified on a BD FACSCalibur to examine endothelial damage and repair associated with the inhalation exposure. Plasma proteins were assessed using the 2D DIGE proteomic approach and commercially available ELISAs. Results and Conclusions. Exposure to inhaled nickel nanoparticles significantly increased both bone marrow EPCs as well as their levels in circulation. CECs were significantly upregulated suggesting that endothelial damage occurred due to the exposure. There was no significant difference in EMPs between the two groups. Tube formation and chemotaxis, but not proliferation, of bone marrow EPCs was impaired in the nickel nanoparticle exposed group. This decrease in EPC function coincided with downregulation of receptors for EPC mobilization and homing. Antioxidant plasma proteins were upregulated post-exposure and transferrin was downregulated. In conclusion, these results indicate that inhalation exposure to Ni nanoparticles below the current OSHA permissible exposure limit for Ni compounds can lead to alterations in bone marrow progenitor cells that may ultimately lead to the development of various cardiovascular diseases.

STUDIES IN THE PATHOGENESIS OF EXPERIMENTAL DYSENTERY INTOXICATION

PubMed Central

Penner, Abraham; Bernheim, Alice Ida

1960-01-01

The introduction of Shiga toxin into the ventricular system of the brain with major location in the third ventricle resulted in a response similar to that following the administration of the toxin either intravenously or by cross-circulation. The intravenous administration at the dosage level employed would have elicited no response. These observations lend support to the hypothesis that Shiga toxin activates some mechanisms in the central nervous system which are capable of producing visceral lesions. These mechanisms are those which control the vasomotor components of homeostasis. This hypothesis permits an explanation of the proximo-distal and intramural features of the lesion. PMID:13734126

Clinical application of a new 0.63- to 0.65-μm pulse diode laser in treating ear, throat, and nose diseases in adults and children

NASA Astrophysics Data System (ADS)

Nasedkin, Alexy N.; Pletnev, A. S.

2001-04-01

An investigation was made of applying a pulsed diode laser emitting at the wavelengths of 0.63 to 0.65 micrometers to treat various otolaryngological diseases, such as rhinosinusitis, acute rhinitis, vasomotor rhinitis, allergic rhinitis, the illness of the lymphoid ring, adenoiditis, chronic tonsillitis, pharyngitis, and catarrhal and suppurative otitis. The therapeutic effect produced by the pulsed diode laser was compared with that of conventional therapeutic lasers. It was found that the pulsed low-intensity laser radiation in the red spectrum region offered a number of advantages over conventional laser therapeutic techniques.

Phentolamine tests and catecholamine levels in normotensive CVA patients.

PubMed

Favazza, A R

1974-11-01

Ten normotensive patients diagnosed as having a CVA had Regitine tests and urinary VMA and catecholamine determinations during the first day of hospitalization. The VMA and catecholamine levels were all within normal limits (except for one elevated VMA level) but did not correlate well with each other. The average response to phentolamine was an average drop in blood pressure of 30mm. Hg systolic and 19 mm. Hg diastolic. Mechanisms by which hypertensive states or cerebral damage might effect blood pressure are discussed. It is suggested that CNS damage might induce a vasolabile or hypersensitive state via connections and consequent alterations in the autonomic vasomotor system.

Investigation of the vascular reaction of the nasal mucosa in cosmonauts

NASA Technical Reports Server (NTRS)

Yakovleva, I. Y.; Baranova, V. P.

1982-01-01

Rhinopneumometric examinations in 3 positions of the body were undertaken in 36 cosmonauts aged 25 to 45 years, 14 of whom participated in space flights of various lengths. The nasal vascular response standards were defined in persons of the group examined. A subjective characteristic of the nasal vascular, reactions arising during the flight is provided. Examinations of 14 people were performed before and after the space flight. The rise of intranasal resistance in the horizontal body position permits forecasting different degrees of nasal breathing disturbances during a period of acute adaptation to weightlessness owing to vasomotor alterations of the nasal mucous membrane.

Role of the medulla oblongata in normal and high arterial blood pressure regulation: the contribution of Escola Paulista de Medicina - UNIFESP.

PubMed

Cravo, Sergio L; Campos, Ruy R; Colombari, Eduardo; Sato, Mônica A; Bergamaschi, Cássia M; Pedrino, Gustavo R; Ferreira-Neto, Marcos L; Lopes, Oswaldo U

2009-09-01

Several forms of experimental evidence gathered in the last 37 years have unequivocally established that the medulla oblongata harbors the main neural circuits responsible for generating the vasomotor tone and regulating arterial blood pressure. Our current understanding of this circuitry derives mainly from the studies of Pedro Guertzenstein, a former student who became Professor of Physiology at UNIFESP later, and his colleagues. In this review, we have summarized the main findings as well as our collaboration to a further understanding of the ventrolateral medulla and the control of arterial blood pressure under normal and pathological conditions.

Effectiveness of Traditional Chinese Acupuncture versus Sham Acupuncture: a Systematic Review.

PubMed

Carlos, Luís; Cruz, Lóris Aparecida Prado da; Leopoldo, Vanessa Cristina; Campos, Fabrício Ribeiro de; Almeida, Ana Maria de; Silveira, Renata Cristina de Campos Pereira

2016-08-15

to identify and synthesize the evidence from randomized clinical trials that tested the effectiveness of traditional Chinese acupuncture in relation to sham acupuncture for the treatment of hot flashes in menopausal women with breast cancer. systematic review guided by the recommendations of the Cochrane Collaboration. Citations were searched in the following databases: MEDLINE via PubMed, Web of Science, CENTRAL, CINAHL, and LILACS. A combination of the following keywords was used: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, and vasomotor symptoms. a total of 272 studies were identified, five of which were selected and analyzed. Slight superiority of traditional acupuncture compared with sham acupuncture was observed; however, there were no strong statistical associations. the evidence gathered was not sufficient to affirm the effectiveness of traditional acupuncture compared with sham acupuncture. identificar e sintetizar as evidências oriundas de ensaios clínicos randomizados que testaram a efetividade da acupuntura tradicional chinesa em relação à sham acupuntura para o tratamento dos fogachos em mulheres com câncer de mama no climatério. revisão sistemática guiada pelas recomendações da Colaboração Cochrane. A busca foi realizada nas bases de dados: MEDLINE via PubMed, Web of Science, CENTRAL Cochrane, CINAHL e LILACS. Adotou-se a combinação dos descritores: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, vasomotor symptoms. foram identificados 272 estudos, sendo 5 selecionados e analisados. Foi observada discreta superioridade da acupuntura tradicional em relação à sham, entretanto, sem fortes associações estatísticas. as evidências obtidas não foram suficientes para afirmar quanto à efetividade da acupuntura tradicional em relação à sham. Identificar y sintetizar la evidencia de un ensayo clínico aleatorizado que examinó la eficacia de la acupuntura tradicional en relación a la acupuntura sham para el tratamiento de sofocos en las mujeres menopáusicas con cáncer de mama. Revisión sistemática guiada por las recomendaciones de la Colaboración Cochrane. Las referencias bibliográficas se buscaron en las siguientes bases de datos: MEDLINE vía PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL y LILACS. Se utilizó una combinación de las siguientes palabras clave: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, vasomotor symptoms. Se identificó un total de 272 estudios, cinco de los cuales fueron seleccionados y analizados. Se encontró una ligera superioridad de la acupuntura tradicional comparada con la acupuntura sham; sin embargo, no se encontraron asociaciones estadísticas fuertes. La evidencia obtenida no fue suficiente para confirmar la eficacia de la acupuntura tradicional comparada con la acupuntura sham.

Supplemental arginine vasopressin during the resuscitation of severe hemorrhagic shock preserves renal mitochondrial function

PubMed Central

Yuxia, Guan; Singh, Khushboo; Reilly, Patrick M.

2017-01-01

Arginine vasopressin (AVP), a hormone secreted by the posterior pituitary, plays a vital role in maintaining vasomotor tone during acute blood loss. We hypothesized that decompensated hemorrhagic shock is associated with decreased AVP stores and supplementation during resuscitation would improve both blood pressure and renal function. Using a decompensated hemorrhagic shock model, male Long-Evans rats were bled to mean arterial blood pressure (MAP) of 40mmHg and maintained until the MAP could not be sustained without fluid. Once 40% of the shed volume was returned in lactated Ringer’s (Severe Shock), animals were resuscitated over 60 minutes with 4x the shed volume in lactated Ringer’s (LR) or the same fluids with AVP (0.5 units/kg+ 0.03 units/kg/min). Animals (n = 6-9/group) were sacrificed before hemorrhage (Sham), at Severe Shock, following resuscitation (60R, 60R with AVP) or 18 hours post-resuscitation (18hr, 18hr with AVP). Blood samples were taken to measure AVP levels and renal function. Pituitaries were harvested and assayed for AVP. Kidney samples were taken to assess mitochondrial function, histology, and oxidative damage. Baseline pituitary AVP stores (30,364 ± 5311 pg/mg) decreased with severe shock and were significantly depressed post-resuscitation (13,910 ± 3016 pg/ml. p<0.05) and at 18hr (15,592 ±1169 pg/ml, p<0.05). Resuscitation with LR+AVP led to higher serum AVP levels at 60R (31±8 vs 79±12; p<0.01) with an improved MAP both at 60R (125±3 vs 77±7mmHg; p<0.01) and 18hr (82±6 vs 69±5mmHg;p<0.05). AVP supplementation preserved complex I respiratory capacity at 60R and both complex I and II function at 18hr (p<0.05). AVP was also associated with decreased reactive oxygen species at 60R (856±67 vs 622±48F RFU) and significantly decreased oxidative damage as measured by mitochondrial lipid peroxidation (0.9±0.1 vs 1.7±0.1 fold change, p<0.01) and nitrosylation (0.9±0.1 vs 1.4±0.2 fold change, p<0.05). With AVP, renal damage was mitigated at 60R and histologic architecture was conserved at 18 hours. In conclusion, pituitary and serum AVP levels decrease during severe hemorrhage and may contribute to the development of decompensated hemorrhagic shock. Supplementing exogenous AVP during resuscitation improves blood pressure, preserves renal mitochondrial function, and mitigates acute kidney injury. PMID:29065123

Validation and Test-Retest Reliability of New Thermographic Technique Called Thermovision Technique of Dry Needling for Gluteus Minimus Trigger Points in Sciatica Subjects and TrPs-Negative Healthy Volunteers

PubMed Central

Rychlik, Michał; Samborski, Włodzimierz

2015-01-01

The aim of this study was to assess the validity and test-retest reliability of Thermovision Technique of Dry Needling (TTDN) for the gluteus minimus muscle. TTDN is a new thermography approach used to support trigger points (TrPs) diagnostic criteria by presence of short-term vasomotor reactions occurring in the area where TrPs refer pain. Method. Thirty chronic sciatica patients (n=15 TrP-positive and n=15 TrPs-negative) and 15 healthy volunteers were evaluated by TTDN three times during two consecutive days based on TrPs of the gluteus minimus muscle confirmed additionally by referred pain presence. TTDN employs average temperature (T avr), maximum temperature (T max), low/high isothermal-area, and autonomic referred pain phenomenon (AURP) that reflects vasodilatation/vasoconstriction. Validity and test-retest reliability were assessed concurrently. Results. Two components of TTDN validity and reliability, T avr and AURP, had almost perfect agreement according to κ (e.g., thigh: 0.880 and 0.938; calf: 0.902 and 0.956, resp.). The sensitivity for T avr, T max, AURP, and high isothermal-area was 100% for everyone, but specificity of 100% was for T avr and AURP only. Conclusion. TTDN is a valid and reliable method for T avr and AURP measurement to support TrPs diagnostic criteria for the gluteus minimus muscle when digitally evoked referred pain pattern is present. PMID:26137486

Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

PubMed

Sloan, M A; Alexandrov, A V; Tegeler, C H; Spencer, M P; Caplan, L R; Feldmann, E; Wechsler, L R; Newell, D W; Gomez, C R; Babikian, V L; Lefkowitz, D; Goldman, R S; Armon, C; Hsu, C Y; Goodin, D S

2004-05-11

To review the use of transcranial Doppler ultrasonography (TCD) and transcranial color-coded sonography (TCCS) for diagnosis. The authors searched the literature for evidence of 1) if TCD provides useful information in specific clinical settings; 2) if using this information improves clinical decision making, as reflected by improved patient outcomes; and 3) if TCD is preferable to other diagnostic tests in these clinical situations. TCD is of established value in the screening of children aged 2 to 16 years with sickle cell disease for stroke risk (Type A, Class I) and the detection and monitoring of angiographic vasospasm after spontaneous subarachnoid hemorrhage (Type A, Class I to II). TCD and TCCS provide important information and may have value for detection of intracranial steno-occlusive disease (Type B, Class II to III), vasomotor reactivity testing (Type B, Class II to III), detection of cerebral circulatory arrest/brain death (Type A, Class II), monitoring carotid endarterectomy (Type B, Class II to III), monitoring cerebral thrombolysis (Type B, Class II to III), and monitoring coronary artery bypass graft operations (Type B to C, Class II to III). Contrast-enhanced TCD/TCCS can also provide useful information in right-to-left cardiac/extracardiac shunts (Type A, Class II), intracranial occlusive disease (Type B, Class II to IV), and hemorrhagic cerebrovascular disease (Type B, Class II to IV), although other techniques may be preferable in these settings.

Substance P and neurokinin A in human nasal mucosa.

PubMed

Baraniuk, J N; Lundgren, J D; Okayama, M; Goff, J; Mullol, J; Merida, M; Shelhamer, J H; Kaliner, M A

1991-03-01

The tachykinins substance P (SP) and neurokinin A (NKA) were studied in human inferior turbinate nasal mucosa by radioimmunoassay, immunohistochemistry, and autoradiography and for their effect upon mucus release in an in vitro culture system in order to infer their potential functions in the upper respiratory tract. Similar amounts of SP (1.03 +/- 0.12 pmol/g wet weight; mean +/- SEM; n = 26) and NKA (0.76 +/- 0.23; n = 7) were found. NKA and SP immunoreactive nerve fibers were found in the walls of arterioles, venules, and sinusoids and as individual fibers in gland acini, near the basement membrane, and in the epithelium. [125I]SP bound to arterioles, venules, and glands. [125I]NKA bound only to arterioles. In short-term explant culture of fragments of human nasal mucosa, both 1 microM SP and 1 microM NKA stimulated release of [3H]glucosamine-labeled respiratory glycoconjugates. These results indicate that SP and NKA have similar distributions in nociceptive sensory nerves in human nasal mucosa. The distribution of [125I]SP binding sites is consistent with a role for SP as a vasodilator and mucous secretagogue. The presence of [125I] NKA binding sites on vessels suggests a primary role for NKA in regulating vasomotor tone.

Feed artery role in blood flow control to rat hindlimb skeletal muscles.

PubMed Central

Williams, D A; Segal, S S

1993-01-01

1. Vasomotor tone and reactivity were investigated in feed arteries of the extensor digitorum longus and soleus muscles. Feed arteries are located external to the muscle and give rise to the microcirculation within each muscle. Resting diameter was smaller in feed arteries of the soleus muscle. 2. Feed arteries of both muscles dilated to similar peak values with sodium nitroprusside. 3. Micropressure measurements demonstrated resistance to blood flow in the feed arteries supplying both muscles. Feed arteries supplying soleus muscle demonstrated greater resistance to blood flow compared to feed arteries of extensor digitorum longus muscle. 4. Greater resting tone and larger pressure drop for feed arteries of soleus muscle suggest greater range of flow control compared to feed arteries of extensor digitorum longus muscle. 5. In both muscles, feed artery diameter increased with muscle contraction (functional dilatation) and in response to transient ischaemia (reactive dilatation). The magnitude of these responses varied between muscles. 6. Feed arteries are active sites of blood flow control in extensor digitorum longus and soleus muscles of the rat. These muscles differ in fibre type and recruitment properties. Differences in feed artery reactivity may contribute to differences in blood flow between these muscles observed at rest and during exercise. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:8246199

Clinical features and pathophysiology of Complex Regional Pain Syndrome – current state of the art

PubMed Central

Marinus, Johan; Moseley, G. Lorimer; Birklein, Frank; Baron, Ralf; Maihöfner, Christian; Kingery, Wade S.; van Hilten, Jacobus J.

2017-01-01

That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS. PMID:21683929

Is complementary and alternative therapy effective for women in the climacteric period?

PubMed

Kim, Mi Young; Choi, Seung Do; Ryu, Aeli

2015-04-01

Vasomotor symptoms start about 2 years prior to menopause in women who are approaching menopause, and early menopause symptoms appear including emotional disturbance and anxiety, followed by physical changes such as vaginal dryness, urinary incontinence and skin wrinkles. As time progresses, osteoporosis, cardiovascular diseases, and dementia occur consecutively. Hormone therapy is primarily considered for the relief of menopause symptoms in postmenopausal women. However, as hormone replacement has emerged as a therapy that increases the potential risk of thrombosis, cerebral infarction and breast cancer, complementary and alternative medicine has drawn much attention. This study aimed to examine the types and effects of evidence-based complementary and alternative therapies that are currently used.

Compartmental and Data-Based Modeling of Cerebral Hemodynamics: Linear Analysis.

PubMed

Henley, B C; Shin, D C; Zhang, R; Marmarelis, V Z

Compartmental and data-based modeling of cerebral hemodynamics are alternative approaches that utilize distinct model forms and have been employed in the quantitative study of cerebral hemodynamics. This paper examines the relation between a compartmental equivalent-circuit and a data-based input-output model of dynamic cerebral autoregulation (DCA) and CO2-vasomotor reactivity (DVR). The compartmental model is constructed as an equivalent-circuit utilizing putative first principles and previously proposed hypothesis-based models. The linear input-output dynamics of this compartmental model are compared with data-based estimates of the DCA-DVR process. This comparative study indicates that there are some qualitative similarities between the two-input compartmental model and experimental results.

Regulation of coronary blood flow during exercise.

PubMed

Duncker, Dirk J; Bache, Robert J

2008-07-01

Exercise is the most important physiological stimulus for increased myocardial oxygen demand. The requirement of exercising muscle for increased blood flow necessitates an increase in cardiac output that results in increases in the three main determinants of myocardial oxygen demand: heart rate, myocardial contractility, and ventricular work. The approximately sixfold increase in oxygen demands of the left ventricle during heavy exercise is met principally by augmenting coronary blood flow (~5-fold), as hemoglobin concentration and oxygen extraction (which is already 70-80% at rest) increase only modestly in most species. In contrast, in the right ventricle, oxygen extraction is lower at rest and increases substantially during exercise, similar to skeletal muscle, suggesting fundamental differences in blood flow regulation between these two cardiac chambers. The increase in heart rate also increases the relative time spent in systole, thereby increasing the net extravascular compressive forces acting on the microvasculature within the wall of the left ventricle, in particular in its subendocardial layers. Hence, appropriate adjustment of coronary vascular resistance is critical for the cardiac response to exercise. Coronary resistance vessel tone results from the culmination of myriad vasodilator and vasoconstrictors influences, including neurohormones and endothelial and myocardial factors. Unraveling of the integrative mechanisms controlling coronary vasodilation in response to exercise has been difficult, in part due to the redundancies in coronary vasomotor control and differences between animal species. Exercise training is associated with adaptations in the coronary microvasculature including increased arteriolar densities and/or diameters, which provide a morphometric basis for the observed increase in peak coronary blood flow rates in exercise-trained animals. In larger animals trained by treadmill exercise, the formation of new capillaries maintains capillary density at a level commensurate with the degree of exercise-induced physiological myocardial hypertrophy. Nevertheless, training alters the distribution of coronary vascular resistance so that more capillaries are recruited, resulting in an increase in the permeability-surface area product without a change in capillary numerical density. Maintenance of alpha- and ss-adrenergic tone in the presence of lower circulating catecholamine levels appears to be due to increased receptor responsiveness to adrenergic stimulation. Exercise training also alters local control of coronary resistance vessels. Thus arterioles exhibit increased myogenic tone, likely due to a calcium-dependent protein kinase C signaling-mediated alteration in voltage-gated calcium channel activity in response to stretch. Conversely, training augments endothelium-dependent vasodilation throughout the coronary microcirculation. This enhanced responsiveness appears to result principally from an increased expression of nitric oxide (NO) synthase. Finally, physical conditioning decreases extravascular compressive forces at rest and at comparable levels of exercise, mainly because of a decrease in heart rate. Impedance to coronary inflow due to an epicardial coronary artery stenosis results in marked redistribution of myocardial blood flow during exercise away from the subendocardium towards the subepicardium. However, in contrast to the traditional view that myocardial ischemia causes maximal microvascular dilation, more recent studies have shown that the coronary microvessels retain some degree of vasodilator reserve during exercise-induced ischemia and remain responsive to vasoconstrictor stimuli. These observations have required reassessment of the principal sites of resistance to blood flow in the microcirculation. A significant fraction of resistance is located in small arteries that are outside the metabolic control of the myocardium but are sensitive to shear and nitrovasodilators. The coronary collateral system embodies a dynamic network of interarterial vessels that can undergo both long- and short-term adjustments that can modulate blood flow to the dependent myocardium. Long-term adjustments including recruitment and growth of collateral vessels in response to arterial occlusion are time dependent and determine the maximum blood flow rates available to the collateral-dependent vascular bed during exercise. Rapid short-term adjustments result from active vasomotor activity of the collateral vessels. Mature coronary collateral vessels are responsive to vasodilators such as nitroglycerin and atrial natriuretic peptide, and to vasoconstrictors such as vasopressin, angiotensin II, and the platelet products serotonin and thromboxane A(2). During exercise, ss-adrenergic activity and endothelium-derived NO and prostanoids exert vasodilator influences on coronary collateral vessels. Importantly, alterations in collateral vasomotor tone, e.g., by exogenous vasopressin, inhibition of endogenous NO or prostanoid production, or increasing local adenosine production can modify collateral conductance, thereby influencing the blood supply to the dependent myocardium. In addition, vasomotor activity in the resistance vessels of the collateral perfused vascular bed can influence the volume and distribution of blood flow within the collateral zone. Finally, there is evidence that vasomotor control of resistance vessels in the normally perfused regions of collateralized hearts is altered, indicating that the vascular adaptations in hearts with a flow-limiting coronary obstruction occur at a global as well as a regional level. Exercise training does not stimulate growth of coronary collateral vessels in the normal heart. However, if exercise produces ischemia, which would be absent or minimal under resting conditions, there is evidence that collateral growth can be enhanced. In addition to ischemia, the pressure gradient between vascular beds, which is a determinant of the flow rate and therefore the shear stress on the collateral vessel endothelium, may also be important in stimulating growth of collateral vessels.

In vivo effects of CB2 receptor-selective cannabinoids on the vasculature of normal and arthritic rat knee joints

PubMed Central

McDougall, J J; Yu, V; Thomson, J

2007-01-01

Background and purpose: Cannabinoids (CBs) are known to be vasoactive and to regulate tissue inflammation. The present study examined the in vivo vasomotor effects of the CB2 receptor agonists JWH015 and JWH133 in rat knee joints. The effect of acute and chronic joint inflammation on CB2 receptor-mediated responses was also tested. Experimental approach: Blood flow was assessed in rat knee joints by laser Doppler imaging both before and following topical administration of CB2 receptor agonists. Vasoactivity was measured in normal, acute kaolin/carrageenan inflamed and Freund's complete adjuvant chronically inflamed knees. Key results: In normal animals, JWH015 and JWH133 caused a concentration-dependent increase in synovial blood flow which in the case of JWH133 was blocked by the selective CB2 receptor antagonist AM630 as well as the transient receptor potential vanilloid-1 (TRPV1) antagonist SB366791. The vasodilator effect of JWH133 was significantly attenuated in both acute and chronically inflamed knees. Given alone, AM630 had no effect on joint blood flow. Conclusion and implications: In normal joints, the cannabinomimetic JWH133 causes hyperaemia via a CB2 and TRPV1 receptor mechanism. During acute and chronic inflammation, however, this vasodilatatory response is significantly attenuated. PMID:17982474

Hormone therapy in menopausal women with cognitive complaints: a randomized, double-blind trial.

PubMed

Maki, P M; Gast, M J; Vieweg, A J; Burriss, S W; Yaffe, K

2007-09-25

To evaluate the effects of hormone therapy (HT) on cognition and subjective quality of life (QoL) in recently postmenopausal women with cognitive complaints. Cognitive Complaints in Early Menopause Trial (COGENT) was a randomized, double-blind, placebo-controlled, multicenter, pilot study of 180 healthy postmenopausal women aged 45 to 55 years, randomly assigned to receive either placebo or conjugated equine estrogen 0.625 mg/medroxyprogesterone acetate 2.5 mg for 4 months. Outcome measures included memory, subjective cognition, QoL, sexuality, and sleep, which were assessed at baseline and month 4. The study was terminated before the expected final sample size of 275 due to a decrease in enrollment coinciding with the publication of findings from the Women's Health Initiative. There were no differences between groups on any cognitive or QoL measures, except for an increase in sexual interest and thoughts with HT. Modest negative effects on short- and long-term verbal memory approached significance (p < 0.10). Women with baseline vasomotor symptoms (VMS) showed a decrease in VMS and an improvement in general QoL, but no cognitive benefit vs placebo. With the power to detect an effect size of >or=0.45, this study suggests potential modest negative effects on verbal memory that are consistent with previous hormone therapy trials in older women.

Reversible sympathetic vasomotor dysfunction in POTS patients.

PubMed

Freitas, J; Santos, R; Azevedo, E; Costa, O; Carvalho, M; de Freitas, A F

2000-11-01

Orthostatic intolerance refers to the development upon assuming an upright posture of disabling symptoms, which are partly relieved by resuming the supine position. Postural tachycardia syndrome (POTS) is an orthostatic intolerance syndrome characterized by palpitations due to excessive orthostatic sinus tachycardia, lightheadedness, tremor, and near-syncope. Patients usually undergo extensive medical, cardiac, endocrine, neurological and psychiatric evaluation, which usually fails to identify a specific abnormality. We investigated the autonomic and hemodynamic profile of POTS patients and the efficacy of bisoprolol and or fludrocortisone. We evaluated eleven female patients with POTS before and after medical treatment with a cardio-selective beta blocker (bisoprolol) and/or fludrocortisone, and eleven age-matched controls. Variability of heart rate and systolic blood pressure was assessed by Fast Fourier Transform, and spontaneous baroreceptor gain by temporal sequences slope and alpha index. Modelflow was used to quantify hemodynamics. All patients improved greatly after medication. The autonomic and hemodynamic impairment observed in patients with POTS, particularly after orthostatic stress, is treated effectively with bisoprolol and/or fludrocortisone. These results need further confirmation in a controlled double-blind study. Proper medical treatment dramatically improves the clinical and autonomic/hemodynamic disturbances observed in patients with POTS. The data support the hypothesis that POTS is due to a hyperadrenergic activation and/or hypovolemia during orthostasis.

Correlation of treatment-emergent adverse events and clinical response to endocrine therapy in early breast cancer: a retrospective analysis of the German cohort of TEAM.

PubMed

Hadji, P; Kieback, D G; Tams, J; Hasenburg, A; Ziller, M

2012-10-01

Previous studies have suggested a correlation between the occurrence of vasomotor or joint symptoms during tamoxifen or aromatase inhibitor treatment and improved clinical response. A retrospective analysis of the German cohort of the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial was carried out to assess disease-free survival (DFS) and overall survival (OS) in patients with and without arthralgia/myalgia and/or menopausal symptoms during adjuvant endocrine treatment. A total of 1502 patients were included; 739 patients received tamoxifen followed by exemestane and 763 received exemestane. Patients reporting arthralgia/myalgia and patients reporting menopausal symptoms during endocrine treatment had significantly longer OS and DFS than those not reporting these events. The effect on OS was irrespective of treatment. DFS was significantly improved in exemestane-treated patients reporting arthralgia/myalgia or those reporting menopausal symptoms versus those not reporting these events. This effect on DFS was not observed in patients receiving sequential treatment. A combined analysis of patients reporting either menopausal symptoms or arthralgia/myalgia showed that OS and DFS were significantly improved in patients reporting one of these symptoms versus those not reporting either symptom. The occurrence of arthralgia/myalgia or menopausal symptoms during endocrine treatment is associated with significantly improved OS.

Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need

PubMed Central

Corcoran, David

2018-01-01

The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease—INOCA). We review new insights into the pathophysiology of angina whereby myocardial ischaemia results from a deficient supply of oxygenated blood to the myocardium, due to various combinations of focal or diffuse epicardial disease (macrovascular), microvascular dysfunction or both. Macrovascular disease may be due to the presence of obstructive CAD secondary to atherosclerosis, or may be dynamic due to a functional disorder (eg, coronary artery spasm, myocardial bridging). Pathophysiology of coronary microvascular disease may involve anatomical abnormalities resulting in increased coronary resistance, or functional abnormalities resulting in abnormal vasomotor tone. We consider novel clinical diagnostic techniques enabling new insights into the causes of angina and appraise the need for improved therapeutic options for patients with INOCA. We conclude that the taxonomy of stable CAD could improve to better reflect the heterogeneous pathophysiology of the coronary circulation. We propose the term ‘stable coronary syndromes’ (SCS), which aligns with the well-established terminology for ‘acute coronary syndromes’. SCS subtends a clinically relevant classification that more fully encompasses the different diseases of the epicardial and microvascular coronary circulation. PMID:29030424

The effect on endothelial function of vitamin C during methionine induced hyperhomocysteinaemia.

PubMed

Hanratty, C G; McGrath, L T; McAuley, D F; Young, I S; Johnston, D G

2001-01-01

Manipulation of total homocysteine concentration with oral methionine is associated with impairment of endothelial-dependent vasodilation. This may be caused by increased oxidative stress. Vitamin C is an aqueous phase antioxidant vitamin and free radical scavenger. We hypothesised that if the impairment of endothelial function related to experimental hyperhomocysteinaemia was free radically mediated then co-administration of vitamin C should prevent this. Ten healthy adults took part in this crossover study. Endothelial function was determined by measuring forearm blood flow (FBF) in response to intra-arterial infusion of acetylcholine (endothelial-dependent) and sodium nitroprusside (endothelial-independent). Subjects received methionine (100 mg/Kg) plus placebo tablets, methionine plus vitamin C (2 g orally) or placebo drink plus placebo tablets. Study drugs were administered at 9 am on each study date, a minimum of two weeks passed between each study. Homocysteine (tHcy) concentration was determined at baseline and after 4 hours. Endothelial function was determined at 4 hours. Responses to the vasoactive substances are expressed as the area under the curve of change in FBF from baseline. Data are mean plus 95% Confidence Intervals. Following oral methionine tHcy concentration increased significantly versus placebo. At this time endothelial-dependent responses were significantly reduced compared to placebo (31.2 units [22.1-40.3] vs. 46.4 units [42.0-50.8], p < 0.05 vs. Placebo). Endothelial-independent responses were unchanged. Co-administration of vitamin C did not alter the increase in homocysteine or prevent the impairment of endothelial-dependent responses (31.4 [19.5-43.3] vs. 46.4 units [42.0-50.8], p < 0.05 vs. Placebo) This study demonstrates that methionine increased tHcy with impairment of the endothelial-dependent vasomotor responses. Administration of vitamin C did not prevent this impairment and our results do not support the hypothesis that the endothelial impairment is mediated by adverse oxidative stress.

Getting inside acupuncture trials - Exploring intervention theory and rationale

PubMed Central

2011-01-01

Background Acupuncture can be described as a complex intervention. In reports of clinical trials the mechanism of acupuncture (that is, the process by which change is effected) is often left unstated or not known. This is problematic in assisting understanding of how acupuncture might work and in drawing together evidence on the potential benefits of acupuncture. Our aim was to aid the identification of the assumed mechanisms underlying the acupuncture interventions in clinical trials by developing an analytical framework to differentiate two contrasting approaches to acupuncture (traditional acupuncture and Western medical acupuncture). Methods Based on the principles of realist review, an analytical framework to differentiate these two contrasting approaches was developed. In order to see how useful the framework was in uncovering the theoretical rationale, it was applied to a set of trials of acupuncture for fatigue and vasomotor symptoms, identified from a wider literature review of acupuncture and early stage breast cancer. Results When examined for the degree to which a study demonstrated adherence to a theoretical model, two of the fourteen selected studies could be considered TA, five MA, with the remaining seven not fitting into any recognisable model. When examined by symptom, five of the nine vasomotor studies, all from one group of researchers, are arguably in the MA category, and two a TA model; in contrast, none of the five fatigue studies could be classed as either MA or TA and all studies had a weak rationale for the chosen treatment for fatigue. Conclusion Our application of the framework to the selected studies suggests that it is a useful tool to help uncover the therapeutic rationale of acupuncture interventions in clinical trials, for distinguishing between TA and MA approaches and for exploring issues of model validity. English language acupuncture trials frequently fail to report enough detail relating to the intervention. We advocate using this framework to aid reporting, along with further testing and refinement of the framework. PMID:21414187

Myoendothelial coupling in the mesenteric arterial bed; segmental differences and interplay between nitric oxide and endothelin-1

PubMed Central

Hilgers, RHP; De Mey, JGR

2009-01-01

Background and purpose: We tested the hypothesis that activated arterial smooth muscle (ASM) stimulates endothelial vasomotor influences via gap junctions and that the significance of this myoendothelial coupling increases with decreasing arterial diameter. Experimental approach: From WKY rats, first-, second-, third-and fourth-order branches of the superior mesenteric artery (MA1, MA2, MA3 and MA4 respectively) were isolated and mounted in wire-myographs to record vasomotor responses to 0.16–20 µmol·L−1 phenylephrine. Key results: Removal of endothelium increased the sensitivity (pEC50) to phenylephrine in all arteries. The nitric oxide (NO) synthase inhibitor Nω-nitro-L-arginine methyl ester (L-NAME) (100 µmol·L−1) did not modify pEC50 to phenylephrine in all denuded arteries, and increased it in intact MA1, MA2 and MA3 to the same extent as denudation. However, in intact MA4, the effect of L-NAME was significantly larger (ΔpEC50 0.57 ± 0.02) than the effect of endothelium removal (ΔpEC50 0.20 ± 0.06). This endothelium-dependent effect of L-NAME in MA4 was inhibited by (i) steroidal and peptidergic uncouplers of gap junctions; (ii) a low concentration of the NO donor sodium nitroprusside; and (iii) by the endothelin-receptor antagonist bosentan. It was also observed during contractions induced by (i) calcium channel activation (BayK 8644, 0.001–1 µmol·L−1); (ii) depolarization (10–40 mmol·L−1 K+); and (iii) sympathetic nerve stimulation (0.25–32 Hz). Conclusions and implications: These pharmacological observations indicated feedback control by endothelium of ASM reactivity involving gap junctions and a balance between endothelium-derived NO and endothelin-1. This myoendothelial coupling was most prominent in distal resistance arteries. PMID:19302591

The role of sleep difficulties in the vasomotor menopausal symptoms and depressed mood relationships: an international pooled analysis of eight studies in the InterLACE consortium.

PubMed

Chung, Hsin-Fang; Pandeya, Nirmala; Dobson, Annette J; Kuh, Diana; Brunner, Eric J; Crawford, Sybil L; Avis, Nancy E; Gold, Ellen B; Mitchell, Ellen S; Woods, Nancy F; Bromberger, Joyce T; Thurston, Rebecca C; Joffe, Hadine; Yoshizawa, Toyoko; Anderson, Debra; Mishra, Gita D

2018-02-12

Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions. A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49-51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation. At baseline, the prevalence of VMS (40%, range 13-62%) and depressed mood (26%, 8-41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27-1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47-2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90-1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38-2.34). Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.

Menopausal symptoms and associated factors in HIV-positive women.

PubMed

Lui-Filho, Jeffrey F; Valadares, Ana Lúcia R; Gomes, Debora de C; Amaral, Eliana; Pinto-Neto, Aarão M; Costa-Paiva, Lúcia

2013-10-01

To evaluate menopausal symptoms and their associated factors in HIV-positive women. A cross-sectional study was conducted with 537 women of 40-60 years of age, 273 of whom were HIV-positive and 264 HIV-negative. The women were interviewed to obtain data on their sociodemographic characteristics and menopausal symptoms. The mean age of the seropositive women was 47.7±5.8 years compared to 49.8±5.3 for the seronegative women (p<0.001). Bivariate analysis showed a lower prevalence of vasomotor symptoms in the seropositive group (p=0.009), specifically hot flashes (p<0.002) and sweating (p=0.049). Vaginal dryness was also less prevalent in this group (p<0.005). There were no statistically significant differences between the groups with respect to depression or insomnia. Multiple analysis showed that hot flashes were associated with being peri- or postmenopausal (PR=2.12; 95%CI: 1.52-2.94). Vaginal dryness was less common in women without a partner (PR=0.67; 95%CI: 0.49-0.90) and was associated with older age (PR=1.03; 95%CI: 1.01-1.06) and being in the peri- or postmenopause (PR=1.69; 95%CI: 1.10-2.60). Depression was inversely associated with being employed (PR=0.74; 95%CI: 0.58-0.96) and directly associated with the presence of chronic diseases (PR=1.30; 95%CI: 1.01-1.067). Insomnia was associated with a lower body mass index (PR=0.96; 95%CI: 0.95-0.97) and with being peri- or postmenopausal (PR=1.48; 95%CI: 1.11-1.97). No correlation was found between HIV serological status and any of the menopausal symptoms. In this study, after controlling for confounding variables, HIV infection was not found to be associated with vasomotor, genitourinary or psychological symptoms or with insomnia. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Prevalence and severity of vasomotor symptoms and joint pain in women at midlife in Bangladesh: a population-based survey.

PubMed

Islam, Rakibul M; Bell, Robin J; Billah, Baki; Hossain, Mohammad B; Davis, Susan R

2016-07-01

The aim of the study was to document the prevalence of menopausal symptoms and the extent to which women are bothered by vasomotor symptoms (VMS) and joint pain in Bangladesh. A total of 1,590 women, aged 30 to 59 years, participated in a cross-sectional, questionnaire-based study between September 2013 and March 2014. The main outcome measures were moderate to severely bothersome VMS and joint pain, measured by the Menopause-Specific Quality of Life questionnaire. Of participants, 59.4% were premenopausal, 8.4% perimenopausal, and 32.3% postmenopausal. Approximately all women reached menopause by the age of 50 years. The prevalence of moderate to severely bothersome VMS was 4.1% in premenopausal, 33.3% in perimenopausal, and 28.2% in postmenopausal women. Factors associated with moderate to severely bothersome VMS were being perimenopausal (odds ratio [OR] 46.34, 95% CI 13.29-161.56; P < 0.001) or postmenopausal (OR 19.15, 95% CI 5.63-65.11; P < 0.001) and obesity (OR 2.20, 95% CI 1.03-4.71; P = 0.042). The prevalence of moderate to severely bothersome joint pain was 40.3% in postmenopausal, 36.2% in perimenopausal, and 15.3% in premenopausal women. Moderate to severely bothersome joint pain was more likely both in perimenopausal (OR 2.64, 95% CI 1.63-4.29; P < 0.001) and postmenopausal women (OR 2.96, 95% CI 2.06-4.24; P < 0.001). Moderate to severely bothersome joint pain was also more likely in women with no education compared with women having education beyond secondary school (OR 2.38, 95% CI 1.02-2.32; P < 0.001). No women reported prescription therapy for menopausal symptoms. This study demonstrates that a high proportion of Bangladeshi women experience moderate to severely bothersome VMS and joint pain. Despite the considerable symptom prevalence, no women reported treatment, suggesting that menopause remains neglected in Bangladesh.

A cross-sectional study of equol producer status and self-reported vasomotor symptoms.

PubMed

Newton, Katherine M; Reed, Susan D; Uchiyama, Shigeto; Qu, Conghui; Ueno, Tomomi; Iwashita, Soh; Gunderson, Gabrielle; Fuller, Sharon; Lampe, Johanna W

2015-05-01

This study aims to evaluate the associations of vasomotor symptom (VMS) frequency, bother, and severity with equol producer status and dietary daidzein intake. This is an observational study. This study included women aged 45 to 55 years, in postmenopause or in the menopausal transition, who had soy food intake of three or more servings per week. Exclusion criteria included severe concurrent disease, pregnancy or planned pregnancy, and current use of oral or transdermal hormones or selective estrogen receptor modulators. After screening, 375 participants completed a 3-day VMS diary and a 24-hour urine collection. Women with a urine daidzein or genistein concentration of 100 ng/mL or higher were included. We evaluated the association of VMS--dichotomized as lower than or equal to versus higher than the mean number of VMS per day (<2.33, ≥ 2.33)--with quartiles of daidzein intake. Overall, 129 (35%) of 365 women were equol producers. The mean (SD) urinary equol excretion was 0.67 (1.57) mg/day (50th percentile, 0 mg/d; 95th percentile, 4.12 mg/d). Among equol producers, the mean (SD) urinary equol excretion was 1.91 (2.15) mg/day (50th percentile, 1.09 mg/d; 95th percentile, 6.27 mg/d). Among equol producers, compared with those in the lowest quartile of dietary daidzein intake (mean, 4.9 mg/d), those in the highest quartile (mean, 28.5 mg/d) were 76% less likely to have VMS higher than the mean number of VMS (odds ratio, 0.24; 95% CI, 0.07-0.83; trend test across all daidzein levels, P = 0.06). Among equol nonproducers, there were no associations between daidzein intake and VMS frequency. There were no differences in VMS bother or severity among equol producers or nonproducers by dietary daidzein level. Among equol producers, higher equol availability attributable to higher soy consumption contributes to decreased VMS.

Indirect hand and forearm vasomotion: Regional variations in cutaneous thermosensitivity during normothermia and mild hyperthermia.

PubMed

Burdon, Catriona A; Tagami, Kyoko; Park, Joonhee; Caldwell, Joanne N; Taylor, Nigel A S

2017-04-01

In this experiment, hand and forearm vasomotor activity was investigated during localised, but stable heating and cooling of the face, hand and thigh, under open-loop (clamped) conditions. It was hypothesised that facial stimulation would provoke the most potent vascular changes. Nine individuals participated in two normothermic trials (mean body temperature clamp: 36.6°C; water-perfused suit and climate chamber) and two mildly hyperthermic trials (37.9°C). Localised heating (+5°C) and cooling (-5°C) stimuli were applied to equal surface areas of the face, hand and thigh (perfusion patches: 15min), while contralateral forearm or hand blood flows (venous-occlusion plethysmography) were measured (separate trials). Thermal sensation and discomfort votes were recorded before and during each thermal stimulation. When hyperthermic, local heating induced more sensitive vascular responses, with the combined thermosensitivity of both limb segments averaging 0.011mL·100mL -1 ·min -1 ·mmHg -1 ·°C -1 , and 0.005mL·100mL -1 ·min -1 ·mmHg -1 ·°C -1 during localised cooling (P<0.05). Inter-site comparisons among the stimulated sites yielded minimal evidence of variations in local thermal sensation, and no differences were observed for vascular conductance (P>0.05). Therefore, regional differences in vasomotor and sensory sensitivity appeared not to exist. When combined with previous observations of sudomotor sensitivity, it seems that, during mild heating and cooling, regional representations within the somatosensory cortex may not translate into meaningful differences in thermal sensation or the central integration of thermoafferent signals. It was concluded that inter-site variations in the cutaneous thermosensitivity of these thermolytic effectors have minimal physiological significance over the ranges investigated thus far. Copyright © 2017 Elsevier Ltd. All rights reserved.

Depressive symptoms across the menopause transition: findings from a large population-based cohort study.

PubMed

Hickey, Martha; Schoenaker, Danielle A J M; Joffe, Hadine; Mishra, Gita D

2016-12-01

The aim of the study was to describe the trajectories of depressive symptoms in a large population-based cohort of midaged women, and to examine the associations of current and changing reproductive stage with depressive symptoms over time. Prospective, population-based cohort study of 13,715 women aged 45 to 50 years followed up for over 15 years (Australian Longitudinal Study on Women's Health). Nearly 6,000 women provided complete data for this study. Menopause status was determined from questionnaires about hysterectomy, oophorectomy, hormone therapy, and menstrual patterns. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale (CESD-10). Latent class analysis indicated four distinct profiles of CESD-10 scores over 15 years: stable low (80.0%), increasing (9.0%), decreasing (8.5%), and stable high (2.5%). Those with "increasing" depressive symptoms were more likely to have had bilateral salpingo-oophorectomy or be perimenopausal at baseline compared with women in the "stable low" group. Depressive symptoms were higher in perimenopausal women, (higher CESD-10 score of 0.19, 95% CI 0.02, 0.31), after hysterectomy alone (0.53, 95% CI 0.31, 0.74), bilateral salpingo-oophorectomy with/without hysterectomy (0.85, 95% CI 0.58, 1.12), hormone therapy users (0.19, 95% CI 0.01, 0.36), and after starting or stopping hormone therapy compared with postmenopausal women (adjusted for sociodemographic factors, vasomotor symptoms, health behaviors, and history of depression diagnosis or treatment). Depressive symptoms follow distinct trajectories across the menopause transition. Most women have stable symptoms, but around 9% have increasing symptoms and a similar proportion (8.5%) decreasing symptoms. Increasing depressive symptoms were independent of vasomotor symptoms but were associated with oophorectomy and stopping or starting hormone therapy. A large number of women were excluded due to missing data, and thus the results should be interpreted with caution.

A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women.

PubMed

Blümel, Juan E; Chedraui, Peter; Baron, German; Belzares, Emma; Bencosme, Ascanio; Calle, Andres; Danckers, Luis; Espinoza, Maria T; Flores, Daniel; Gomez, Gustavo; Hernandez-Bueno, Jose A; Izaguirre, Humberto; Leon-Leon, Patricia; Lima, Selva; Mezones-Holguin, Edward; Monterrosa, Alvaro; Mostajo, Desire; Navarro, Daysi; Ojeda, Eliana; Onatra, William; Royer, Monique; Soto, Edwin; Tserotas, Konstantinos; Vallejo, Soledad

2011-07-01

The aim of this study was to determine vasomotor symptom (VMS) prevalence, duration, and impact on quality of life in middle-aged women using a validated menopausal tool. The Menopause Rating Scale (MRS) and an itemized questionnaire containing personal sociodemographic data were used to examine 8,373 women aged 40 to 59 years from 22 healthcare centers in 12 Latin American countries. Less than half (48.8%) of all women studied were postmenopausal, 14.7% used hormone therapy (HT), 54.5% presented VMS of any degree, and 9.6% presented severe/bothersome symptoms. The rate of VMS (any degree) significantly increased from one menopausal stage to the next. HT users presented more VMS (any degree) than did nonusers (58.6% vs 53.8%, P = 0.001). When surgical postmenopausal women were compared, non-HT users displayed a higher prevalence of severe VMS (16.1% vs 9.0%, P = 0.0001). The presence of VMS of any degree was related to a more impaired quality of life (higher total MRS score; odds ratio, 4.7; 95% CI, 4.1-5.3). This effect was even higher among women presenting severe VMS. Logistic regression analysis determined that the presence of severe psychological/urogenital symptoms (MRS), lower educational level, natural perimenopause-postmenopause status, nulliparity, surgical menopause, and living at high altitude were significant risk factors for severe VMS. HT use was related to a lower risk. A second regression model determined that surgical menopause, intense psychological/urogenital symptoms, and a history of psychiatric consultation were factors related to severe VMS persisting into the late postmenopausal stage (5 or more years). In this Latin American middle-aged series, VMS prevalence was high, persisting into the late postmenopausal phase in a high rate and severely impairing quality of life. HT use was related to a lower risk of severe VMS.

A comparative study on the effects of Hypericum Perforatum and passion flower on the menopausal symptoms of women referring to Isfahan city health care centers.

PubMed

Fahami, Fariba; Asali, Zahra; Aslani, Abolfazl; Fathizadeh, Nahid

2010-01-01

With regard to an increase in the life expectancy for women and the consistency of the menopause age, a significant portion of women's age is passed after the menopause. Menopause is considered as a critical and sensitive period due to the changes and the disorders that are involved in it. Vasomotor symptoms, sleep disorders and psycho-mental changes are among the most prevalent symptoms of this period. Hormone therapy is a common treatment and it involves some problems for most individuals. The purpose of this study was to comparatively examine the effects of two herbal medications, Hypericum Perforatum and Passion Flower, on menopause symptoms. This study was of a clinical-experimental type which was done in 1388 in Isfahan. The sample included 59 menopausal women who had the conditions for entering into the study. The individuals were selected via simple sampling and were assigned randomly into two groups of Hypericum Perforatum treatment group (30 women) and Passion Flower group (29 women). The required data were filled out through interview, Personal Characteristics Questionnaire, and Cooperman's Index for menopause symptoms in three stages of pre-intervention, the third week of intervention, and the sixth week of intervention. The results were analyzed by descriptive and inferential statistical methods and the statistical software of SPSS. The findings showed that the average score of menopause symptoms in two treatment groups of Hypericum Perforatum and Passion Flower had a significant decrease throughout the third and the sixth weeks of study (p < 0.05). In addition, there was no statistically significant difference between the two groups and both herbs equally resulted in a decrease in the menopause symptoms scores (p > 0.05). With regard to the effects of Hypericum Perforatum and Passion Flower on treating menopause precocious symptoms (vasomotor signs, insomnia, depression, anger, headache, etc.), these two herbs can be used as an alternative treatment for individuals who cannot, whatsoever, use hormone therapy.

Role of GPER in estrogen-dependent nitric oxide formation and vasodilation.

PubMed

Fredette, Natalie C; Meyer, Matthias R; Prossnitz, Eric R

2018-02-01

Estrogens are potent regulators of vasomotor tone, yet underlying receptor- and ligand-specific signaling pathways remain poorly characterized. The primary physiological estrogen 17β-estradiol (E2), a non-selective agonist of classical nuclear estrogen receptors (ERα and ERβ) as well as the G protein-coupled estrogen receptor (GPER), stimulates formation of the vasodilator nitric oxide (NO) in endothelial cells. Here, we studied the contribution of GPER signaling in E2-dependent activation of endothelial NO formation and subsequent vasodilation. Employing E2 and the GPER-selective agonist G-1, we investigated eNOS phosphorylation and NO formation in human endothelial cells, and endothelium-dependent vasodilation in the aortae of wild-type and Gper-deficient mice. Both E2 and G-1 induced phosphorylation of eNOS at the activation site Ser1177 to similar extents. Endothelial NO production to E2 was comparable to that of G-1, and was substantially reduced after pharmacological inhibition of GPER. Similarly, the clinically used ER-targeting drugs 4OH-tamoxifen, raloxifene, and ICI182,780 (faslodex, fulvestrant™) induced NO formation in part via GPER. We identified c-Src, EGFR, PI3K and ERK signaling pathways to be involved in GPER-dependent NO formation. In line with activation of NO formation in cells, E2 and G-1 induced equally potent vasodilation in the aorta of wild-type mice. Gper deletion completely abrogated the vasodilator response to G-1, while reducing the response to E2 by ∼50%. These findings indicate that a substantial portion of E2-induced endothelium-dependent vasodilation and NO formation is mediated by GPER. Thus, selective targeting of vascular GPER may be a suitable approach to activate the endothelial NO pathway, possibly leading to reduced vasomotor tone and inhibition of atherosclerotic vascular disease. Copyright © 2017 Elsevier Ltd. All rights reserved.

Actions of rilmenidine on neurogenic hypertension in BPH/2J genetically hypertensive mice.

PubMed

Jackson, Kristy L; Palma-Rigo, Kesia; Nguyen-Huu, Thu-Phuc; Davern, Pamela J; Head, Geoffrey A

2014-03-01

BPH/2J hypertensive mice have an exaggerated sympathetic contribution to blood pressure (BP). Premotor sympathetic neurons within the rostroventrolateral medulla (RVLM) are a major source of sympathetic vasomotor tone and major site of action of the centrally acting sympatholytic agent, rilmenidine. The relative cardiovascular effect of rilmenidine in BPH/2J versus normotensive BPN/3J mice was used as an indicator of the involvement of the RVLM in the sympathetic contribution to hypertension in BPH/2J mice. BPH/2J and BPN/3J mice were pre-implanted with telemetry devices to measure BP in conscious unrestrained mice. Rilmenidine was administered acutely (n=7-9/group), orally for 14 days, at a wide range of doses (n=5/group), and also infused intracerebroventricularly for 7 days (n=6/group). Acute intraperitoneal rilmenidine induced greater depressor and bradycardic responses in BPH/2J than BPN/3J mice (Pstrain<0.01). Both responses were reduced by atropine pre-treatment, with the remaining hypotensive effect being small and comparable between strains (Pstrain=1.0). This suggests that vagally induced reductions in cardiac output were responsible for the hypotension. Chronic intracerebroventricularly infused rilmenidine reduced BP from baseline marginally in BPH/2J mice during the dark (active) period (-6.5 ± 2 mmHg; P=0.006). Chronic orally administered rilmenidine (1-12 mg/kg per day) also had minimal effect on 24-h BP in both strains (P>0.16). The sympathetic vasomotor inhibitory effect of rilmenidine is minimal in both strains and similar in hypertensive BPH/2J and BPN/3J mice. Thus, hypertension in BPH/2J mice is not likely mediated by greater neuronal activity in the RVLM, and agents such as rilmenidine would be an ineffective treatment for this form of neurogenic hypertension.

Validity, cut-points, and minimally important differences for two hot flash-related daily interference scales.

PubMed

Carpenter, Janet S; Bakoyannis, Giorgos; Otte, Julie L; Chen, Chen X; Rand, Kevin L; Woods, Nancy; Newton, Katherine; Joffe, Hadine; Manson, JoAnn E; Freeman, Ellen W; Guthrie, Katherine A

2017-08-01

To conduct psychometric analyses to condense the Hot Flash-Related Daily Interference Scale (HFRDIS) into a shorter form termed the Hot Flash Interference (HFI) scale; evaluate cut-points for both scales; and establish minimally important differences (MIDs) for both scales. We analyzed baseline and postrandomization patient-reported data pooled across three randomized trials aimed at reducing vasomotor symptoms (VMS) in 899 midlife women. Trials were conducted across five MsFLASH clinical sites between July 2009 and October 2012. We eliminated HFRDIS items based on experts' content validity ratings and confirmatory factor analysis, and evaluated cut-points and established MIDs by mapping HFRDIS and HFI to other measures. The three-item HFI (interference with sleep, mood, and concentration) demonstrated strong internal consistency (alphas of 0.830 and 0.856), showed good fit to the unidimensional "hot flash interference factor," and strong convergent validity with HFRDIS scores, diary VMS, and menopausal quality of life. For both scales, cut-points of mild (0-3.9), moderate (4-6.9), and severe (7-10) interference were associated with increasing diary VMS ratings, sleep, and anxiety. The average MID was 1.66 for the HFRDIS and 2.34 for the HFI. The HFI is a brief assessment of VMS interference and will be useful in busy clinics to standardize VMS assessment or in research studies where response burden may be an issue. The scale cut-points and MIDs should prove useful in targeting those most in need of treatment, monitoring treatment response, and interpreting existing and future research findings.

The capuchin monkey as a flight candidate

NASA Technical Reports Server (NTRS)

Winget, C. M.

1977-01-01

The highly evolved nervous system and associated complex behavioral capabilities of the nonhuman primates make them good candidates for certain studies in the space environment since deleterious changes in these more complex aspects of a biological status can only be demonstrated by species which share such highly evolved features with man. Important assets which urge the selection of the capuchin monkey for space experiments include his small size, high intelligence, relative disease resistance, nutritional requirements, and lower volume life support systems. The species is particularly suited for experiments on the nervous system or on process under neural control because of the similarity of capuchin and human blood chemistry profiles and endocrine systems involved in the maintenance of homeostasis and vasomotor tone.

Herbal preparations for the menopause: beyond isoflavones and black cohosh.

PubMed

Depypere, Herman T; Comhaire, Frank H

2014-02-01

Complementary and alternative medicines (CAM) such as isoflavones and black cohosh are commonly used to deal with menopausal symptoms, but benefit a limited proportion of women. The aim of this minireview is to summarize the evidence of the efficacy and safety of other herbal preparations. Randomized controlled trials (RCTs) find that the extracts of Mediterranean pine bark (Pycnogenol(®)), linseed, and Lepididium meyenii (Maca) reduce vasomotor symptoms. The results of RCTs of the hop flavonoid 8-prenylnaringenin are conflicting. Animal and human studies suggest that Dioscorea villosa (Wild yam),and Broccoli may protect against osteoporosis and breast and gynecological cancers but further evidence is required. Linseed may protect against breast cancer but the results are conflicting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Jeremiah Metzger Lecture. The pathogenesis of fever in human subjects.

PubMed Central

Wolff, S. M.; Dinarello, C. A.

1980-01-01

The pathogenesis of fever in man begins with the production of endogenous pyrogen by phagocytic leukocytes in response to exogenous pyrogens (toxic, immunologic or infectious agents). Endogenous pyrogen, a protein, is released from a variety of phagocytic leukocytes and enters the circulation after new messenger RNA and protein are synthesized. Fever is caused by an interaction of endogenous pyrogen with specialized receptors on or near thermosensitive neurons in the thermoregulatory center of the anterior hypothalamus. This interaction may cause local hypothalamic production of prostaglandins, monoamines and, possibly, cyclic AMP. From the anterior hypothalamus, information is transmitted through the posterior hypothalamus to the vasomotor center, which directs sympathetic-nerve fibers to constrict peripheral vessels and decrease heat dissipation. PMID:552177

Pathophysiology of increased cerebrospinal fluid pressure associated to brain arteriovenous malformations: The hydraulic hypothesis.

PubMed

Rossitti, Sandro

2013-01-01

Brain arteriovenous malformations (AVMs) produce circulatory and functional disturbances in adjacent as well as in remote areas of the brain, but their physiological effect on the cerebrospinal fluid (CSF) pressure is not well known. The hypothesis of an intrinsic disease mechanism leading to increased CSF pressure in all patients with brain AVM is outlined, based on a theory of hemodynamic control of intracranial pressure that asserts that CSF pressure is a fraction of the systemic arterial pressure as predicted by a two-resistor series circuit hydraulic model. The resistors are the arteriolar resistance (that is regulated by vasomotor tonus), and the venous resistance (which is mechanically passive as a Starling resistor). This theory is discussed and compared with the knowledge accumulated by now on intravasal pressures and CSF pressure measured in patients with brain AVM. The theory provides a basis for understanding the occurrence of pseudotumor cerebri syndrome in patients with nonhemorrhagic brain AVMs, for the occurrence of local mass effect and brain edema bordering unruptured AVMs, and for the development of hydrocephalus in patients with unruptured AVMs. The theory also contributes to a better appreciation of the pathophysiology of dural arteriovenous fistulas, of vein of Galen aneurismal malformation, and of autoregulation-related disorders in AVM patients. The hydraulic hypothesis provides a comprehensive frame to understand brain AVM hemodynamics and its effect on the CSF dynamics.

Pathophysiology of increased cerebrospinal fluid pressure associated to brain arteriovenous malformations: The hydraulic hypothesis

PubMed Central

Rossitti, Sandro

2013-01-01

Background: Brain arteriovenous malformations (AVMs) produce circulatory and functional disturbances in adjacent as well as in remote areas of the brain, but their physiological effect on the cerebrospinal fluid (CSF) pressure is not well known. Methods: The hypothesis of an intrinsic disease mechanism leading to increased CSF pressure in all patients with brain AVM is outlined, based on a theory of hemodynamic control of intracranial pressure that asserts that CSF pressure is a fraction of the systemic arterial pressure as predicted by a two-resistor series circuit hydraulic model. The resistors are the arteriolar resistance (that is regulated by vasomotor tonus), and the venous resistance (which is mechanically passive as a Starling resistor). This theory is discussed and compared with the knowledge accumulated by now on intravasal pressures and CSF pressure measured in patients with brain AVM. Results: The theory provides a basis for understanding the occurrence of pseudotumor cerebri syndrome in patients with nonhemorrhagic brain AVMs, for the occurrence of local mass effect and brain edema bordering unruptured AVMs, and for the development of hydrocephalus in patients with unruptured AVMs. The theory also contributes to a better appreciation of the pathophysiology of dural arteriovenous fistulas, of vein of Galen aneurismal malformation, and of autoregulation-related disorders in AVM patients. Conclusions: The hydraulic hypothesis provides a comprehensive frame to understand brain AVM hemodynamics and its effect on the CSF dynamics. PMID:23607064

Alpha-1 adrenoceptor hyperresponsiveness in three neuropathic pain states: complex regional pain syndrome 1, diabetic peripheral neuropathic pain and central pain states following spinal cord injury.

PubMed

Teasell, Robert W; Arnold, J Malcolm O

2004-01-01

The pathophysiology of the pain associated with complex regional pain syndrome, spinal cord injury and diabetic peripheral neuropathy is not known. The pain of complex regional pain syndrome has often been attributed to abnormal sympathetic nervous system activity based on the presence of vasomotor instability and a frequently reported positive response, albeit a temporary response, to sympathetic blockade. In contrast, the pain below the level of spinal cord injury and diabetic peripheral neuropathy are generally seen as deafferentation phenomena. Each of these pain states has been associated with abnormal sympathetic nervous system function and increased peripheral alpha-1 adrenoceptor activity. This increased responsiveness may be a consequence of alpha-1 adrenoceptor postsynaptic hypersensitivity, or alpha-2 adrenoceptor presynaptic dysfunction with diminished noradrenaline reuptake, increased concentrations of noradrenaline in the synaptic cleft and increased stimulation of otherwise normal alpha-1 adrenoceptors. Plausible mechanisms based on animal research by which alpha-1 adrenoceptor hyperresponsiveness can lead to chronic neuropathic-like pain have been reported. This raises the intriguing possibility that sympathetic nervous system dysfunction may be an important factor in the generation of pain in many neuropathic pain states. Although results to date have been mixed, there may be a greater role for new drugs which target peripheral alpha-2 adrenoceptors (agonists) or alpha-1 adrenoceptors (antagonists).

Supportive care of women with breast cancer: key concerns and practical solutions.

PubMed

Zdenkowski, Nicholas; Tesson, Stephanie; Lombard, Janine; Lovell, Melanie; Hayes, Sandra; Francis, Prudence A; Dhillon, Haryana M; Boyle, Frances M

2016-11-21

Patients diagnosed with breast cancer may have supportive care needs for many years after diagnosis. High quality multidisciplinary care can help address these needs and reduce the physical and psychological effects of breast cancer and its treatment. Ovarian suppression and extended endocrine therapy benefits are associated with vasomotor, musculoskeletal, sexual and bone density-related side effects. Aromatase inhibitor musculoskeletal syndrome is a common reason for treatment discontinuation. Treatment strategies include education, exercise, simple analgesia and a change to tamoxifen or another aromatase inhibitor. Chemotherapy-induced alopecia may be a constant reminder of breast cancer to the patient, family, friends, acquaintances and even strangers. Alopecia can be prevented in some patients using scalp-cooling technology applied at the time of chemotherapy infusion. The adverse impact of breast cancer diagnosis and treatment on sexual wellbeing is under-reported. Identification of physical and psychological impacts is needed for implementation of treatment strategies. Fear of cancer recurrence reduces quality of life and increases distress, with subsequent impact on role functioning. Identification and multidisciplinary management are key, with referral to psychosocial services recommended where indicated. The benefits of exercise include reduced fatigue, better mental health and reduced musculoskeletal symptoms, and may also include reduced incidence of breast cancer recurrence. Identification and management of unmet supportive care needs are key aspects of breast cancer care, to maximise quality of life and minimise breast cancer recurrence.

Cardiovascular control in Antarctic fish

NASA Astrophysics Data System (ADS)

Egginton, Stuart; Campbell, Hamish; Davison, William

2006-04-01

The capacity for synthesis and plasma levels of stress hormones in species with a range of activity patterns suggest that depressed catecholamine synthesis is typical of notothenioid fishes regardless of life style, although they are able to release extensive stores under conditions of extreme trauma. Cortisol does not appear to be an important primary stress hormone in these species. In general, vascular reactivity shows a modest α and β adrenergic tonus, but with greater potency for cholinergic and serotonergic vasoconstrictor agonists, although a dominance of vasodilatation over vasoconstriction is observed in one species. Vasomotor control mechanisms appear to be primarily a consequence of evolutionary lineage rather than low environmental temperature, but the pattern may be modified according to functional demand. These and other data confirm the cardiovascular system is dominated by cholinergic control: the heart apparently lacks adrenergic innervation, but receives inhibitory parasympathetic input that regulates heart rate (HR) by setting a resting vagal tonus. Oxygen consumption (MO 2) determined at rest and varied via specific dynamic action, in intact fish and fish that had undergone bilateral sectioning of the vagus nerve, show that HR is a good predictor of MO 2, and that the major influence on HR is the degree of vagal tone—these fish work by removing the brake rather than applying the accelerator. However, whether these traits actually represent adaptation to the Antarctic environment or merely represent ancestral characteristics and their relative phylogenetic position is at present unclear.

Gender differences in climacteric symptoms and associated factors in Korean men and women.

PubMed

Yeom, Hyun-E

2018-06-01

Both men and women may experience multifaceted symptoms that are part of natural aging throughout the climacteric period. This study compared the prevalence and severity of climacteric symptoms between genders and identified the underlying clusters of climacteric symptoms and associated factors in midlife men and women. A cross-sectional study was done with 254 middle-aged Korean men (n = 129, M = 50.4) and women (n = 125, M = 49.5). Data were collected by self-administered surveys and analyzed using t-tests, chi-square tests, exploratory factor analysis, and regression analysis. Significant gender differences in overall climacteric symptoms were not detected except for muscle weakness, weight gain, and hot flashes. Climacteric symptoms were clustered as physical, vasomotor-genital, psychological, and metabolic dimensions, with the physical dimension being the most explanatory cluster. A significant gender effect was found only in the metabolic dimension after adjusting for the relevant covariates, and regular eating was significantly associated with all symptom clusters. This study offers evidence that most climacteric symptoms are shared by both men and women and emphasizes the importance of healthier lifestyles in the climacteric transition period. The findings highlight the critical need for integrated assessments of the multifactorial symptoms and of modifying poor lifestyles in both genders throughout the climacteric transition period. Copyright © 2018 Elsevier Inc. All rights reserved.

MsFLASH participants' priorities for alleviating menopausal symptoms.

PubMed

Carpenter, J S; Woods, N F; Otte, J L; Guthrie, K A; Hohensee, C; Newton, K M; Joffe, H; Cohen, L; Sternfeld, B; Lau, R J; Reed, S D; LaCroix, A Z

2015-01-01

To describe self-reported menopausal symptom priorities and their association with demographics and other symptoms among participants in an intervention trial for vasomotor symptoms (VMS). Cross-sectional study embedded in the MsFLASH 02 trial, a three-by-two factorial design of yoga vs. exercise vs. usual activity and omega-3-fatty acid vs. placebo. At baseline, women (n = 354) completed hot flush diaries, a card sort task to prioritize symptoms they would most like to alleviate, and standardized questionnaires. The most common symptom priorities were: VMS (n = 322), sleep (n = 191), concentration (n = 140), and fatigue (n = 116). In multivariate models, women who chose VMS as their top priority symptom (n = 210) reported significantly greater VMS severity (p = 0.004) and never smoking (p = 0.012), and women who chose sleep as their top priority symptom (n = 100) were more educated (p ≤ 0.001) and had worse sleep quality (p < 0.001). ROC curves identified sleep scale scores that were highly predictive of ranking sleep as a top priority symptom. Among women entering an intervention trial for VMS and with relatively low prevalence of depression and anxiety, VMS was the priority symptom for treatment. A card sort may be a valid tool for quickly assessing symptom priorities in clinical practice and research.

Stellate ganglion blockade and verbal memory in midlife women: Evidence from a randomized trial.

PubMed

Maki, Pauline M; Rubin, Leah H; Savarese, Antonia; Drogos, Lauren; Shulman, Lee P; Banuvar, Suzanne; Walega, David R

2016-10-01

In a pilot randomized clinical trial of active stellate ganglion blockade (SGB) versus sham control, SGB significantly reduced the frequency of reported moderate to severe vasomotor symptoms (VMS) and the frequency of physiologic VMS measured using ambulatory skin conductance monitors. Here we examine secondary effects of SGB on verbal learning and memory. In a randomized, sham-controlled study, 36 women met eligibility criteria for cognitive assessments, of whom 17 were randomized to receive fluoroscopy-guided SGB and 19 to sham control. At baseline and three months post-treatment, women completed tests of verbal learning and memory (primary outcome) and other cognitive measures and also wore an ambulatory monitor for 24h to measure physiologic VMS and VMS reported in real time. Verbal learning improved following active SGB (p<0.05) but not sham treatment; however, the interaction between group and time was not significant (p values 0.13-0.20). Two secondary cognitive measures improved only in the sham group. Improvements in physiologic VMS correlated significantly with improvements in verbal learning (r=0.51, p<0.05). SGB might confer benefits to memory in relation to the magnitude of improvement in physiologic VMS. Broadly these findings suggest a possible link between physiologic VMS and memory problems in midlife women. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Are Slow Waves of Intracranial Pressure Suppressed by General Anaesthesia?

PubMed

Lalou, Despina Afroditi; Czosnyka, Marek; Donnelly, Joseph; Lavinio, Andrea; Pickard, John D; Garnett, Matthew; Czosnyka, Zofia

2018-01-01

Slow waves of intracranial pressure (ICP) are spontaneous oscillations with a frequency of 0.3-4 cycles/min. They are often associated with pathological conditions, following vasomotor activity in the cranial enclosure. This study quantifies the effects of general anaesthesia (GA) on the magnitude of B-waves compared with natural sleep and the conscious state. Four groups of 30 patients each were formed to assess the magnitude of slow waves. Group A and group B consisted of normal pressure hydrocephalus (NPH) patients, each undergoing cerebrospinal fluid (CSF) infusion studies, conscious and under GA respectively. Group C comprised conscious, naturally asleep hydrocephalic patients undergoing overnight ICP monitoring; group D, which included deeply sedated head injury patients monitored in the intensive care unit (ICU), was compared with group C. The average amplitude for group A patients was higher (0.23 ± 0.10 mmHg) than that of group B (0.15 ± 0.10 mmHg; p = 0.01). Overnight magnitude of slow waves was higher in group C (0.20 ± 0.13 mmHg) than in group D (0.11 ± 0.09 mmHg; p = 0.002). Slow waves of ICP are suppressed by GA and deep sedation. When using slow waves in clinical decision-making, it is important to consider the patients' level of consciousness to avoid incorrect therapeutic and management decisions.

Self-reported sleep difficulty during the menopausal transition: results from a prospective cohort study

PubMed Central

Tom, Sarah E.; Kuh, Diana; Guralnik, Jack M.; Mishra, Gita

2011-01-01

Objective To examine the relationship between menopausal transition status and self-reported sleep difficulty. Methods Using data on women participating in the Medical Research Council National Survey of Health and Development who have been followed up from birth in March 1946 (n = 962), relationships between menopausal transition status and self-reported sleep difficulty were assessed annually between ages 48 – 54. Results Menopausal transition status was related to severe self-reported sleep difficulty. Odds of reporting severe self-reported sleep difficulty were increased approximately 2 to 3.5 fold (95% CI ranges from (1.08, 3.27) – (1.99, 6.04)) for most menopausal transition statuses, compared to women who remained premenopausal. After adjustment for current psychological, vasomotor, and somatic symptoms and waking frequently at night to use the toilet, only women with hysterectomy remained at an increased risk for moderate sleep difficulty. Conclusions The modest relationship between menopausal transition status and moderate sleep difficulty may be related to greater variation in individual definitions of moderate difficulty. Attention to the level of sleep difficulty in this group of women will assist in the decision to address current health symptoms versus sleep itself. Women without prior health problems may experience severe self-reported sleeping difficulty during the menopausal transition and require tailored care from health professionals. PMID:20551846

Effects of neutral endopeptidase (neprilysin) inhibition on the response to other vasoactive peptides in small human resistance arteries: studies with thiorphan and omapatrilat.

PubMed

Dalzell, Jonathan R; Seed, Alison; Berry, Colin; Whelan, Carol J; Petrie, Mark C; Padmanabhan, Neal; Clarke, Amanda; Biggerstaff, Fiona; Hillier, Christopher; McMurray, John J V

2014-02-01

New compounds with neprilysin or neutral endopeptidase (NEP) inhibiting activity are under clinical investigation in heart failure and hypertension. We investigated the effect of NEP inhibition on the functional vasomotor responses to a range of vasoactive peptides in human blood vessels. Small human resistance arteries from patients with coronary artery disease and preserved left ventricular systolic function were studied. Thiorphan (a NEP inhibitor) was compared with captopril (an ACE inhibitor) and omapatrilat (a dual NEP-ACE inhibitor) with regard to their effects on the response of human arteries to key vasoactive peptides. As expected, both captopril and omapatrilat (but not thiorphan) inhibited the vasoconstrictor effect of angiotensin I (maximal response [SEM]: 27 ± 8% vehicle, 6 ± 2% captopril, 39 ± 10% thiorphan, 8 ± 7% omapatrilat, P < 0.05). Thiorphan, captopril, and omapatrilat all enhanced the vasodilator response to bradykinin (all P < 0.01). Omapatrilat markedly augmented the vasodilator action of adrenomedullin (P < 0.05), whilst thiorphan and captopril did not. None of the three inhibitors studied affected the vasodilator action of c-type natriuretic peptide, calcitonin gene-related peptide, vasoactive intestinal polypeptide or substance P. NEP inhibition with thiorphan modestly augmented the vasodilator action of bradykinin, but did not potentiate the response to adrenomedullin; dual ACE and NEP inhibition with omapatrilat, as expected, markedly augmented the response to bradykinin and also potentiated the effect of adrenomedullin. Thiorphan weakly enhanced the vasoconstrictor response to angiotensin I. Neither omapatrilat nor thiorphan had any effect on the action of a range of other vasoactive peptides including CNP. © 2013 John Wiley & Sons Ltd.

Spaceflight on the Bion-M1 biosatellite alters cerebral artery vasomotor and mechanical properties in mice

PubMed Central

Sofronova, Svetlana I.; Tarasova, Olga S.; Gaynullina, Dina; Borzykh, Anna A.; Behnke, Bradley J.; Stabley, John N.; McCullough, Danielle J.; Maraj, Joshua J.; Hanna, Mina; Muller-Delp, Judy M.; Vinogradova, Olga L.

2015-01-01

Conditions during spaceflight, such as the loss of the head-to-foot gravity vector, are thought to potentially alter cerebral blood flow and vascular resistance. The purpose of the present study was to determine the effects of long-term spaceflight on the functional, mechanical, and structural properties of cerebral arteries. Male C57BL/6N mice were flown 30 days in a Bion-M1 biosatellite. Basilar arteries isolated from spaceflight (SF) (n = 6), habitat control (HC) (n = 6), and vivarium control (VC) (n = 16) mice were used for in vitro functional and mechanical testing and histological structural analysis. The results demonstrate that vasoconstriction elicited through a voltage-gated Ca2+ mechanism (30–80 mM KCl) and thromboxane A2 receptors (10−8 − 3 × 10−5 M U46619) are lower in cerebral arteries from SF mice. Inhibition of Rho-kinase activity (1 μM Y27632) abolished group differences in U46619-evoked contractions. Endothelium-dependent vasodilation elicited by acetylcholine (10 μM, 2 μM U46619 preconstriction) was virtually absent in cerebral arteries from SF mice. The pressure-diameter relation was lower in arteries from SF mice relative to that in HC mice, which was not related to differences in the extracellular matrix protein elastin or collagen content or the elastin/collagen ratio in the basilar arteries. Diameter, medial wall thickness, and medial cross-sectional area of unpressurized basilar arteries were not different among groups. These results suggest that the microgravity-induced attenuation of both vasoconstrictor and vasodilator properties may limit the range of vascular control of cerebral perfusion or impair the distribution of brain blood flow during periods of stress. PMID:25593287

Adenosine triphosphate as a molecular mediator of the vascular response to injury.

PubMed

Guth, Christy M; Luo, Weifung; Jolayemi, Olukemi; Chadalavada, Kalyan S; Komalavilas, Padmini; Cheung-Flynn, Joyce; Brophy, Colleen M

2017-08-01

Human saphenous veins used for arterial bypass undergo stretch injury at the time of harvest and preimplant preparation. Vascular injury promotes intimal hyperplasia, the leading cause of graft failure, but the molecular events leading to this response are largely unknown. This study investigated adenosine triphosphate (ATP) as a potential molecular mediator in the vascular response to stretch injury, and the downstream effects of the purinergic receptor, P2X7R, and p38 MAPK activation. A subfailure stretch rat aorta model was used to determine the effect of stretch injury on release of ATP and vasomotor responses. Stretch-injured tissues were treated with apyrase, the P2X7R antagonist, A438079, or the p38 MAPK inhibitor, SB203580, and subsequent contractile forces were measured using a muscle bath. An exogenous ATP (eATP) injury model was developed and the experiment repeated. Change in p38 MAPK phosphorylation after stretch and eATP tissue injury was determined using Western blotting. Noninjured tissue was incubated in the p38 MAPK activator, anisomycin, and subsequent contractile function and p38 MAPK phosphorylation were analyzed. Stretch injury was associated with release of ATP. Contractile function was decreased in tissue subjected to subfailure stretch, eATP, and anisomycin. Contractile function was restored by apyrase, P2X7R antagonism, and p38-MAPK inhibition. Stretch, eATP, and anisomycin-injured tissue demonstrated increased phosphorylation of p38 MAPK. Taken together, these data suggest that the vascular response to stretch injury is associated with release of ATP and activation of the P2X7R/P38 MAPK pathway, resulting in contractile dysfunction. Modulation of this pathway in vein grafts after harvest and before implantation may reduce the vascular response to injury. Copyright © 2017 Elsevier Inc. All rights reserved.

Carbon dioxide‐mediated vasomotion of extra‐cranial cerebral arteries in humans: a role for prostaglandins?

PubMed Central

Tymko, Michael M.; Bain, Anthony R.; Wildfong, Kevin W.; Monteleone, Brad; Ainslie, Philip N.

2016-01-01

Key points Cerebral blood flow increases during hypercapnia and decreases during hypocapnia; it is unknown if vasomotion of the internal carotid artery is implicated in these responses.Indomethacin, a non‐selective cyclooxygenase inhibitor (used to inhibit prostaglandin synthesis), has a unique ability to blunt cerebrovascular carbon dioxide reactivity, while other cyclooxygenase inhibitors have no effect.We show significant dilatation and constriction of the internal carotid artery during hypercapnia and hypocapnia, respectively.Indomethacin, but not ketorolac or naproxen, reduced the dilatatory response of the internal carotid artery to hypercapniaThe differential effect of indomethacin compared to ketorolac and naproxen suggests that indomethacin inhibits vasomotion of the internal carotid artery independent of prostaglandin synthesis inhibition. Abstract Extra‐cranial cerebral blood vessels are implicated in the regulation of cerebral blood flow during changes in arterial CO2; however, the mechanisms governing CO2‐mediated vasomotion of these vessels in humans remain unclear. We determined if cyclooxygenase inhibition with indomethacin (INDO) reduces the vasomotor response of the internal carotid artery (ICA) to changes in end‐tidal CO2 (P ETC O2). Using a randomized single‐blinded placebo‐controlled study, participants (n = 10) were tested on two occasions, before and 90 min following oral INDO (1.2 mg kg–1) or placebo. Concurrent measurements of beat‐by‐beat velocity, diameter and blood flow of the ICA were made at rest and during steady‐state stages (4 min) of iso‐oxic hypercapnia (+3, +6, +9 mmHg P ETC O2) and hypocapnia (−3, −6, −9 mmHg P ETC O2). To examine if INDO affects ICA vasomotion independent of cyclooxygenase inhibition, two participant subsets (each n = 5) were tested before and following oral ketorolac (post 45 min, 0.25 mg kg–1) or naproxen (post 90 min, 4.2 mg kg–1). During pre‐drug testing in the INDO trial, the ICA dilatated during hypercapnia at +6 mmHg (4.72 ± 0.45 vs. 4.95 ± 0.51 mm; P < 0.001) and +9 mmHg (4.72 ± 0.45 mm vs. 5.12 ± 0.47 mm; P < 0.001), and constricted during hypocapnia at −6 mmHg (4.95 ± 0.33 vs. 4.88 ± 0.27 mm; P < 0.05) and −9 mmHg (4.95 ± 0.33 vs. 4.82 ± 0.27 mm; P < 0.001). Following INDO, vasomotor responsiveness of the ICA to hypercapnia was reduced by 67 ± 28% (0.045 ± 0.015 vs. 0.015 ± 0.012 mm mmHg P ETC O2 −1). There was no effect of the drug in the ketorolac and naproxen trials. We conclude that: (1) INDO markedly reduces the vasomotor response of the ICA to changes in P ETC O2; and (2) INDO may be reducing CO2‐mediated vasomotion via a mechanism(s) independent of cyclooxygenase inhibition. PMID:26880615

Favorable effects of carotid endarterectomy on baroreflex sensitivity and cardiovascular neural modulation: a 4-month follow-up.

PubMed

Dalla Vecchia, Laura; Barbic, Franca; Galli, Andrea; Pisacreta, Massimo; Gornati, Rosella; Porretta, Tiziano; Porta, Alberto; Furlan, Raffaello

2013-06-15

Carotid surgery variably modifies carotid afferent innervation, thus affecting arterial baroreceptor sensitivity. Low arterial baroreflex sensitivity is a well-known independent risk factor for cardiovascular diseases. The aim of this study was to assess the 4-mo effects of carotid endarterectomy (CEA) on arterial baroreceptor sensitivity and cardiovascular autonomic profile in patients with unilateral carotid stenosis. We enrolled 20 patients (72 ± 8 yr) with unilateral >70% carotid stenosis. ECG, beat-by-beat blood pressure, and respiration were continuously recorded before and 126 ± 9 days after CEA, at rest and during a 75° head-up tilt. Both pharmacological (modified Oxford technique, BRS) and spontaneous (index α, spectral analysis) arterial baroreflex sensitivity were assessed. Cardiovascular autonomic profile was evaluated by plasma catecholamines and spectral indexes of cardiac sympathovagal modulation [low-frequency R-R interval (LFRR), low frequency-to high frequency ratio (LF/HF), high-frequency R-R interval (HFRR)] and sympathetic vasomotor control [low-frequency systolic arterial pressure (LFSAP)] obtained from heart rate and SAP variability. After CEA, both the index α and BRS were higher (P < 0.02) at rest. SAP variance decreased both at rest and during tilt (P < 0.02). Before surgery, tilt did not modify the autonomic profile compared with baseline. After CEA, tilt increased LF/HF and LFSAP and reduced HFRR compared with rest (P < 0.02). Four months after CEA was performed, arterial baroreflex sensitivity was enhanced. Accordingly, the patients' autonomic profile had shifted toward reduced cardiac and vascular sympathetic activation and enhanced cardiac vagal activity. The capability to increase cardiovascular sympathetic activation in response to orthostasis was restored. Baroreceptor sensitivity improvement might play an additional role in the more favorable outcome observed in patients after carotid surgery.

Microvascular versus macrovascular cerebral vasomotor reactivity in patients with severe internal carotid artery stenosis or occlusion.

PubMed

Zirak, Peyman; Delgado-Mederos, Raquel; Dinia, Lavinia; Martí-Fàbregas, Joan; Durduran, Turgut

2014-02-01

In patients with severe internal carotid artery steno-occlusive lesions (ISOL), impaired cerebrovascular reactivity (CVR) is predictive of future ischemic stroke (IS) or transient ischemic attack (TIA). Therefore, the evaluation of CVR in ISOL patients may be a means to evaluate the risk for IS/TIA and decide on an intervention. Our aim was (1) to explore the feasibility of concurrent near-infrared spectroscopy (NIRS-DOS), diffuse correlation spectroscopy, and transcranial Doppler for CVR assessment in ISOL patients, and (2) to compare macrovascular and microvascular CVR in ISOL patients and explore its potential for IS/TIA risk stratification. Twenty-seven ISOL patients were recruited. The changes in continuous microvascular and macrovascular hemodynamics upon acetazolamide injection were used to determine CVR. Oxyhemoglobin (HbO2, by near-infrared spectroscopy), microvascular cerebral blood flow (CBF, by diffuse correlation spectroscopy) and CBF velocity (by transcranial Doppler) showed significant increases upon acetazolamide injection in all subjects (P < .03). Only macrovascular CVR (P = .024) and none of the microvascular measures were significantly dependent on the presence of ISOL. In addition, while CBF was significantly correlated with HbO2, neither of these microvascular measures correlated with macrovascular CBF velocity. We demonstrated the simultaneous, continuous, and noninvasive evaluation of CVR at both the microvasculature and macrovasculature. We found that macrovascular CVR response depends on the presence of ISOL, whereas the microvascular CVR did not significantly depend on the ISOL presence, possibly due to the role of collaterals other than those of the circle of Willis. The concurrent microvascular and macrovascular CVR measurement in the ISOL patients might improve future IS/TIA risk assessment. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Association of objectively measured physical activity and physical fitness with menopause symptoms. The Flamenco Project.

PubMed

Aparicio, V A; Borges-Cosic, M; Ruiz-Cabello, P; Coll-Risco, I; Acosta-Manzano, P; Špacírová, Z; Soriano-Maldonado, A

2017-10-01

The primary aim was to analyze the association of moderate-to-vigorous physical activity (MVPA) with menopause symptomatology and its overall impact. A secondary/exploratory aim was to assess the association of different components of physical fitness with menopause symptomatology. This cross-sectional study comprised 191 perimenopausal women from Southern Spain (age range 45-60 years, mean age 52.6 ± 4.5 years). The Blatt-Kupperman Menopausal Index was used to evaluate menopause symptomatology. Objectively measured MVPA was registered with accelerometry. Physical fitness was assessed with the Senior Fitness Test battery plus handgrip strength and sit-and-reach tests. After adjustment for multiple confounders, MVPA was only inversely associated with vertigo (r = -0.185, p < 0.05) and palpitations (r = -0.148, p < 0.05). Upper-body flexibility was inversely associated with the Blatt-Kupperman Menopausal Index global score (r = -0.147, p < 0.05). This test was also inversely associated with vertigo (r = -0.230, p < 0.01) and arthralgia (r = -0.168, p < 0.05). Lower-body muscle strength was associated with lower nervousness (r = -0.171, p < 0.05). Cardiorespiratory fitness was inversely associated with paresthesia (r = -0.158, p < 0.05), vertigo (r = -0.219, p < 0.01), fatigue (r = -0.159, p < 0.05) and arthralgia (r = -0.180, p < 0.05). The main findings of the present study indicate a weak association of objectively measured MVPA with menopause symptomatology. Exploratory analyses suggest that upper-body flexibility was associated with slightly lower overall menopause impact whereas neither MVPA nor any physical fitness components studied were associated with vasomotor symptoms.

Topography of itch: evidence of distinct coding for pruriception in the trigeminal nerve

PubMed Central

Andersen, Hjalte H.; Elberling, Jesper; Lo Vecchio, Silvia

2017-01-01

Introduction: Little is known about the topographical distribution of pruriception (in particular for nonhistaminergic itch), although conditions with chronic itch frequently occur in distinct anatomic and often bilateral patterns. This study aimed to investigate regional differences in the sensitivity to itch stimuli by assessing the intensity of itch, pain, and cutaneous neurogenic flare evoked by histamine and cowhage in different anatomic regions in 20 healthy volunteers. Methods: Itch was induced by 1% histamine applied with a prick lancet or by insertion of 25±5 cowhage spicules in 4 regions: volar/dorsal forearm, lower back, and chin. The duration and intensity of itch and pain following each pruritic stimulus were measured by a continuous visual analogue scale (VAS0-100). Sensitivity to touch-evoked itch was assessed by von Frey filaments and cutaneous flare was quantified by full-field laser perfusion imaging. Results: Peak itch intensity was lower at the chin (19.4±3.6) compared with other areas (mean of 3 locations; 41.3±4.4), independently of whether histamine or cowhage was applied (P<0.01). Baseline sensitivity to touch-evoked itch was higher on the chin (P<0.01), but here hyperknesis did not develop in contrast to other areas (P<0.05). Cutaneous flare was more intense but had a smaller dispersion at the chin, compared with other areas (P<0.01). Discussion: In conclusion, sensitivity to histaminergic and non-histaminergic itch diverges considerably between body regions. Lower density of pruriceptive CMH and CMI-neurons or distinct neuronal substrates for itch in the mandibular part of the trigeminal area may explain the observed reduced itch and vasomotor responses. PMID:29862321

A FURTHER EXPERIMENTAL STUDY ON EXCITATION OF INFECTIONS OF THE THROAT

PubMed Central

Grant, Samuel B.; Mudd, Stuart; Goldman, Alfred

1920-01-01

Improvements are described in the method of following temperature changes, and thus alterations in vasomotor tone, in exposed mucous membranes. Invention of an applicator holder, by means of which more sure and stable apposition of the thermopile terminals to the mucous surface may be effected has been the chief advance. Minor improvements have been the use of a saliva ejector and of better calibration technique. The palatine tonsils, like the palate, pharynx, and skin, react to chilling of the body surface with reflex vasoconstriction and ischemia. On rewarming the subject the tonsils quickly more than recover their former blood supply, actually becoming hyperemic; the skin returns to about its control condition; the pharynx and palate remain somewhat ischemic. The hypothesis is advanced that one factor in the beneficial hardening effect of cold bathing and outdoor living, with its incident heightened immunity to respiratory infection, may be the training of the vasomotor system in the direction of development in the pharynx of a reaction of hyperemia following chilling, similar to that observed in the tonsils of the present subjects. With inhalation of amyl nitrite, the skin temperature has always shown a sharp transient rise. The mucous membrane, if relatively ischemic, responds by a rise corresponding to the skin flush. If already hyperemic, local vasodilation in the mucous membrane with amyl nitrite is more than counterbalanced by the lowering of the general blood pressure, and the temperature falls. The flora of the pharynx and tonsils, studied by the unsatisfactory method described, showed, in several instances, after experimentation changes apparently due to proliferation of one of the microorganisms already present. In one case Streptococcus hæmolyticus, in one Micrococcus catarrhalis, and in a third Bacillus influenzæ was the organism showing a relative increase in numbers. The first two instances were associated with sore throat, the third with slight constitutional symptoms. The chilling in the experiments in no instance produced albuminuria or glycosuria, although a more dilute urine was apparently excreted during the experiments. A fall in hydrogen ion concentration, referable to the forced respiration, was noted. PMID:19868432

Vasomotor symptoms and cardiovascular events in postmenopausal women

PubMed Central

Szmuilowicz, Emily D.; Manson, JoAnn E.; Rossouw, Jacques E.; Howard, Barbara V.; Margolis, Karen L.; Greep, Nancy C.; Brzyski, Robert G.; Stefanick, Marcia L.; O'Sullivan, Mary Jo; Wu, Chunyuan; Allison, Matthew; Grobbee, Diederick E.; Johnson, Karen C.; Ockene, Judith K.; Rodriguez, Beatriz L.; Sarto, Gloria E.; Vitolins, Mara Z.; Seely, Ellen W.

2010-01-01

Objective Emerging evidence suggests that women with menopausal vasomotor symptoms (VMS) have increased cardiovascular disease (CVD) risk as measured by surrogate markers. We investigated the relationships between VMS and clinical CVD events and all-cause mortality in the Women's Health Initiative Observational Study (WHI-OS). Methods We compared the risk of incident CVD events and all-cause mortality between four groups of women (total N=60,027): (1) No VMS at menopause onset and no VMS at WHI-OS enrollment (no VMS [referent group]); (2) VMS at menopause onset, but not at WHI-OS enrollment (early VMS); (3) VMS at both menopause onset and WHI-OS enrollment (persistent VMS [early and late]); and (4) VMS at WHI-OS enrollment, but not at menopause onset (late VMS). Results For women with early VMS (N=24,753), compared to no VMS (N=18,799), hazard ratios (HRs) and 95% confidence intervals (CIs) in fully-adjusted models were: major CHD, 0.94 (0.84, 1.06); stroke, 0.83 (0.72, 0.96); total CVD, 0.89 (0.81, 0.97); and all-cause mortality, 0.92 (0.85, 0.99). For women with persistent VMS (N=15,084), there was no significant association with clinical events. For women with late VMS (N=1,391) compared to no VMS, HRs and 95% CIs were: major CHD, 1.32 (1.01, 1.71); stroke, 1.14 (0.82, 1.59); total CVD, 1.23 (1.00, 1.52); and all-cause mortality, 1.29 (1.08, 1.54). Conclusions Early VMS were not associated with increased CVD risk. Rather, early VMS were associated with decreased risk of stroke, total CVD events, and all-cause mortality. Late VMS were associated with increased CHD risk and all-cause mortality. The predictive value of VMS for clinical CVD events may vary with onset of VMS at different stages of menopause. Further research examining the mechanisms underlying these associations is needed. Future studies will also be necessary to investigate whether VMS that develop for the first time in the later postmenopausal years represent a pathophysiologic process distinct from classical perimenopausal VMS. PMID:21358352

Stimulation of sensory neuropeptide release by nociceptin/orphanin FQ leads to hyperaemia in acutely inflamed rat knees

PubMed Central

Zhang, Chunfen; McDougall, Jason J

2006-01-01

The peripheral effect of the ‘opioid-like' peptide nociceptin/orphanin FQ (N/OFQ) on joint blood flow was investigated in acutely inflamed rats. Sensory neuropeptide release from capsaicin-sensitive nerves and the involvement of synovial mast cells and leukocytes on these vasomotor responses were also studied. Blood flow measurements of exposed knee joints were performed in urethane-anaesthetised rats (2 mg kg−1 intraperitoneal) using laser Doppler perfusion imaging. Topical administration of N/OFQ (10−13–10−8 mol) to acutely inflamed joints caused a dose-dependent increase in synovial perfusion with an ED50 of 4.0 × 10−10 mol. This vasodilatatory response was blocked by the selective NOP receptor antagonist [Phe1-(CH2-NH)-Gly2]-Nociceptin(1–13)-NH2 (10−9 mol) (P<0.0001). Co-administration of N/OFQ with the neurokinin-1 (NK1) receptor antagonist [D-Arg1,D-Phe5,D-Trp7,9,Leu11]-Substance P (10−12 mol), the vasoactive intestinal peptide (VIP) receptor antagonist VIP6–28 (10−9 mol) or the calcitonin gene-related peptide (CGRP) receptor antagonist CGRP8–37 (10−9 mol) all blocked the hyperaemic effect of N/OFQ (P<0.0001). Treatment of acutely inflamed knees with capsaicin (8-methyl-N-vanillyl-6-noneamide) to destroy unmyelinated joint afferents also inhibited N/OFQ vasomotor activity. Stabilisation of synovial mast cells with disodium cromoglycate (cromolyn) ameliorated N/OFQ responses, whereas inactivation of circulating leukocytes with the pan-selectin inhibitor fucoidin completely blocked N/OFQ-induced hyperaemia in these joints. These experiments show that in acutely inflamed knee joints, N/OFQ acts on NOP receptors located on synovial mast cells and leukocytes leading to the secondary release of proinflammatory mediators into the joint. These agents subsequently stimulate sensory neuropeptide release from capsaicin-sensitive nerves culminating in vasodilatation and increased articular blood flow. PMID:16783411

History of vasomotor symptoms, extent of coronary artery disease, and clinical outcomes after acute coronary syndrome in postmenopausal women.

PubMed

Ferri, Luca A; Morici, Nuccia; Bassanelli, Giorgio; Franco, Nicoletta; Misuraca, Leonardo; Lenatti, Laura; Jacono, Emilia Lo; Leuzzi, Chiara; Corrada, Elena; Aranzulla, Tiziana C; Colombo, Delia; Cagnacci, Angelo; Prati, Francesco; Savonitto, Stefano

2018-06-01

Vasomotor symptoms (VMS) during menopausal transition have been linked to a higher burden of cardiovascular risk factors, subclinical vascular disease, and subsequent vascular events. We aim to investigate the association of VMS with the extent of coronary disease and their prognostic role after an acute coronary syndrome. The Ladies Acute Coronary Syndrome study enrolled consecutive women with an acute coronary syndrome undergoing coronary angiography. A menopause questionnaire was administered during admission. Angiographic data underwent corelab analysis. Six out of 10 enrolling centers participated in 1-year follow-up. Outcome data included the composite endpoint of all-cause mortality, recurrent myocardial infarction, stroke, and rehospitalization for cardiovascular causes within 1 year. Of the 415 women with available angiographic corelab analysis, 373 (90%) had complete 1-year follow-up. Among them, 202 women had had VMS during menopausal transition. These women had the same mean age at menopause as those without VMS (50 years in both groups), but were younger at presentation (median age 71 vs 76 years; P < 0.001), despite a more favorable cardiovascular risk profile (chronic kidney dysfunction 4.5% vs 15.9%; P = 0.001; prior cerebrovascular disease 4.5 vs 12.2%; P = 0.018). Extent of coronary disease at angiography was similar between groups (mean Gensini score 49 vs 51; P = 0.6; mean SYNTAX score 14 vs 16; P = 0.3). Overall cardiovascular events at 1 year did not differ between groups (19% vs 22%; P = 0.5). In postmenopausal women with an acute coronary syndrome, a history of VMS was associated with younger age at presentation, despite a lower vascular disease burden and similar angiographically defined coronary disease as compared with women without VMS. No difference could be found in terms of overall clinical outcomes. These results should be interpreted cautiously as all analyses were unadjusted and did not account for risk factor differences between women with and without a history of VMS.

The re-innervation of the tongue and salivary glands after lingual nerve repair by stretch, sural nerve graft or frozen muscle graft.

PubMed

Smith, K G; Robinson, P P

1995-12-01

The lingual nerve is sometimes injured during the surgical removal of impacted third molar teeth and may require repair. Removal of the damaged section of nerve prior to repair leaves a gap between the nerve ends, and we have investigated methods of closing the gap. THe characteristics of regenerated fibers in the chorda tympani have been recorded in cats 24 weeks after the removal of a segment of lingual nerve and repair of the defect by three methods. The nerve gap was closed either by stretching the nerve ends together and repairing under tension, or by the insertion of a sural nerve graft or freeze-thawed muscle graft. The properties of gustatory, thermosensitive, and mechanosensitive units and the return of the vasomotor and secretomotor responses were investigated by electrophysiological techniques and the data from each of the repair groups compared with those obtained from a series of normal control animals. After each method of repair, the integrated whole-nerve activity recorded from the chorda tympani during gustatory or thermal stimulation of the tongue was reduced when compared with controls, but there was little significant difference between the repair groups. Recordings made from single units in the chorda tympani revealed that conduction velocities were faster after stretch repair than after sural nerve graft or frozen muscle graft. In addition, 48% of the units had developed into principally gustatory units after stretch repair, indicating a better level of recovery than in the graft groups, which contained 33% and 32%, respectively. The secretomotor responses were also significantly greater after stretch repair than in either of the graft groups or the controls, but there was no difference in the vasomotor responses. These results reveal that repair of a short gap in the lingual nerve by stretching the ends together is followed by better overall recovery than after grafting, but where a graft is used, a similar level of recovery results from use of a frozen muscle graft or a sural nerve graft.

Vesicular glutamate transporter DNPI/VGLUT2 is expressed by both C1 adrenergic and nonaminergic presympathetic vasomotor neurons of the rat medulla.

PubMed

Stornetta, Ruth L; Sevigny, Charles P; Schreihofer, Ann M; Rosin, Diane L; Guyenet, Patrice G

2002-03-12

The main source of excitatory drive to the sympathetic preganglionic neurons that control blood pressure is from neurons located in the rostral ventrolateral medulla (RVLM). This monosynaptic input includes adrenergic (C1), peptidergic, and noncatecholaminergic neurons. Some of the cells in this pathway are suspected to be glutamatergic, but conclusive evidence is lacking. In the present study we sought to determine whether these presympathetic neurons express the vesicular glutamate transporter BNPI/VGLUT1 or the closely related gene DNPI, the rat homolog of the mouse vesicular glutamate transporter VGLUT2. Both BNPI/VGLUT1 and DNPI/VGLUT2 mRNAs were detected in the medulla oblongata by in situ hybridization, but only DNPI/VGLUT2 mRNA was present in the RVLM. Moreover, BNPI immunoreactivity was absent from the thoracic spinal cord lateral horn. DNPI/VGLUT2 mRNA was present in many medullary cells retrogradely labeled with Fluoro-Gold from the spinal cord (T2; four rats). Within the RVLM, 79% of the bulbospinal C1 cells contained DNPI/VGLUT2 mRNA. Bulbospinal noradrenergic A5 neurons did not contain DNPI/VGLUT2 mRNA. The RVLM of six unanesthetized rats subjected to 2 hours of hydralazine-induced hypotension contained tenfold more c-Fos-ir DNPI/VGLUT2 neurons than that of six saline-treated controls. c-Fos-ir DNPI/VGLUT2 neurons included C1 and non-C1 neurons (3:2 ratio). In seven barbiturate-anesthetized rats, 16 vasomotor presympathetic neurons were filled with biotinamide and analyzed for the presence of tyrosine hydroxylase immunoreactivity and/or DNPI/VGLUT2 mRNA. Biotinamide-labeled neurons included C1 and non-C1 cells. Most non-C1 (9/10) and C1 presympathetic cells (5/6) contained DNPI/VGLUT2 mRNA. In conclusion, DNPI/VGLUT2 is expressed by most blood pressure-regulating presympathetic cells of the RVLM. The data suggest that these neurons may be glutamatergic and that the C1 adrenergic phenotype is one of several secondary phenotypes that are differentially expressed by subgroups of these cells. Copyright 2002 Wiley-Liss, Inc.

Duration of menopausal vasomotor symptoms over the menopause transition.

PubMed

Avis, Nancy E; Crawford, Sybil L; Greendale, Gail; Bromberger, Joyce T; Everson-Rose, Susan A; Gold, Ellen B; Hess, Rachel; Joffe, Hadine; Kravitz, Howard M; Tepper, Ping G; Thurston, Rebecca C

2015-04-01

The expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments. To determine total duration of frequent VMS (≥ 6 days in the previous 2 weeks) (hereafter total VMS duration) during the menopausal transition, to quantify how long frequent VMS persist after the final menstrual period (FMP) (hereafter post-FMP persistence), and to identify risk factors for longer total VMS duration and longer post-FMP persistence. The Study of Women's Health Across the Nation (SWAN) is a multiracial/multiethnic observational study of the menopausal transition among 3302 women enrolled at 7 US sites. From February 1996 through April 2013, women completed a median of 13 visits. Analyses included 1449 women with frequent VMS. Total VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause. The median total VMS duration was 7.4 years. Among 881 women who experienced an observable FMP, the median post-FMP persistence was 4.5 years. Women who were premenopausal or early perimenopausal when they first reported frequent VMS had the longest total VMS duration (median, >11.8 years) and post-FMP persistence (median, 9.4 years). Women who were postmenopausal at the onset of VMS had the shortest total VMS duration (median, 3.4 years). Compared with women of other racial/ethnic groups, African American women reported the longest total VMS duration (median, 10.1 years). Additional factors related to longer duration of VMS (total VMS duration or post-FMP persistence) were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS. Frequent VMS lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the FMP. Individual characteristics (eg, being premenopausal and having greater negative affective factors when first experiencing VMS) were related to longer-lasting VMS. Health care professionals should counsel women to expect that frequent VMS could last more than 7 years, and they may last longer for African American women.

Impaired lung transfer factor in fibromyalgia syndrome.

PubMed

Rizzi, Maurizio; Atzeni, Fabiola; Airoldi, Andrea; Masala, Ignazio Francesco; Frassanito, Francesca; Salaffi, Fausto; Macaluso, Claudio; Sarzi-Puttini, Piercarlo

2016-01-01

The aim of this study was to evaluate whether pulmonary diffusing capacity is impaired in patients with fibromyalgia (FM) as it is in those with other diseases characterised by autonomic nerve system (ANS) dysfunction such as type 1 diabetes. Forty-five consecutive anti-nuclear antibody (ANA)-negative female Caucasian patients aged 50.1± 5.6 years with FM and compared with 45 healthy female control volunteers matched in terms of age and body mass index (BMI). The autonomic function has been evaluated by means of standard electrocardiography (ECG), finger blood pressure respiration, and muscle sympathetic nerve activity (MSNA) at rest and during a stepwise tilt test up to 75°. Their autonomic profiles were drawn up on the basis of MSNA, plasma catecholamine levels, and spectral indices of cardiac sympathetic and vagal modulation, and sympathetic vasomotor control computed by means of the spectrum analysis of RR and systolic arterial pressure (SAP) variability. Lung volumes and dynamic spirometry parameters were assessed by means of plethysmography. All of the patients were clinically evaluated and completed the FQI and COMPASS questionnaire. There was no difference in lung volumes between the FM patients and healthy controls, but DLCO (83±4 vs. 96±5; p<0.001), Kco (84±5 vs 98±5; p<0.001), DM (12.7±2.4 vs 13.6±1.8; p<0.05) and Vc (48±3.9 vs 65±7; p<0.001) were significantly reduced in the patients. The COMPASS-31, RCS and pain VAS scores significantly correlated with DLCO, Kco and Vc with the correlation being particularly close in the case of Vc. Furthermore, univariate Cox proportional hazard analysis showed that the three scores were all significantly associated with an increased risk of impaired DLCO (respectively, χ(2) 16.21, p<0.0005; χ(2) 7.09, p<0.005; χ(2) 6.37, p<0.01). FM impairs DLCO mainly as a result of a reduction in Vc, and that this defect is inversely proportional to the severity of the dysfunction suggesting a relationship between impaired DLCO and autonomic nerve dysfunction.

Age-related differences in health complaints: the Hilo women's health study.

PubMed

Sievert, Lynnette Leidy; Morrison, Lynn A; Reza, Angela M; Brown, Daniel E; Kalua, Erin; Tefft, Harold A T

2007-01-01

The purpose of this study was to determine the age distribution of health-related complaints and symptom groupings from a random postal survey carried out in the multi-ethnic city of Hilo, Hawaii. Symptom frequencies and factor analyses were compared across three age categories: < 40 (32%), 40-60 (48%), and > 60 years (19%), (n = 1,796). Younger women were most likely to report headaches, menstrual complaints, irritability, and mood swings. Women at midlife were most likely to report fluid retention, trouble sleeping, loss of sexual desire, vasomotor symptoms, and nervous tension. Older women reported the least number of symptoms overall. Using multiple linear regression, menopause status, ethnicity, and alcohol intake were significantly associated with the factor scores for symptoms of menopause, after controlling for age, education, BMI, exercise, smoking habits, and financial comfort.

RGS4 inhibits angiotensin II signaling and macrophage localization during renal reperfusion injury independent of vasospasm

PubMed Central

Pang, Paul; Jin, Xiaohua; Proctor, Brandon M.; Farley, Michelle; Roy, Nilay; Chin, Matthew S.; von Andrian, Ulrich H.; Vollmann, Elisabeth; Perro, Mario; Hoffman, Ryan J.; Chung, Joseph; Chauhan, Nikita; Mistri, Murti; Muslin, Anthony J.; Bonventre, Joseph V.; Siedlecki, Andrew M.

2014-01-01

Vascular inflammation is a major contributor to the severity of acute kidney injury. In the context of vasospasm-independent reperfusion injury we studied the potential anti-inflammatory role of the Gα-related RGS protein, RGS4. Transgenic RGS4 mice were resistant to 25 minute injury, although post-ischemic renal arteriolar diameter was equal to the wild type early after injury. A 10 minute unilateral injury was performed to study reperfusion without vasospasm. Eighteen hours after injury blood flow was decreased in the inner cortex of wild type mice with preservation of tubular architecture. Angiotensin II levels in the kidneys of wild type and transgenic mice were elevated in a sub-vasoconstrictive range 12 and 18 hours after injury. Angiotensin II stimulated pre-glomerular vascular smooth muscle cells (VSMC) to secrete the macrophage chemoattractant, RANTES; a process decreased by angiotensin II R2 (AT2) inhibition. However, RANTES increased when RGS4 expression was suppressed implicating Gα protein activation in an AT2-RGS4-dependent pathway. RGS4 function, specific to VSMC, was tested in a conditional VSMC-specific RGS4 knockout showing high macrophage density by T2 MRI compared to transgenic and non-transgenic mice after the 10 minute injury. Arteriolar diameter of this knockout was unchanged at successive time points after injury. Thus, RGS4 expression, specific to renal VSMC, inhibits angiotensin II-mediated cytokine signaling and macrophage recruitment during reperfusion, distinct from vasomotor regulation. PMID:25469849

Menopause and work--the experience of middle-aged female teaching staff in an Egyptian governmental faculty of medicine.

PubMed

Hammam, Rehab A M; Abbas, Reem A; Hunter, Myra S

2012-03-01

There is a global trend of increasing numbers of older women in the workforce. However, limited information is available regarding the relationship between the menopause transition and work, especially in developing countries. The objectives of this study were to investigate the relationship between experience of the menopause transition and work and to examine the factors affecting how women cope, including the extent to which women disclosed their menopausal status. Using a cross-sectional single group design, 131 middle-aged female medical teaching staff working in Zagazig Faculty of Medicine completed questionnaires and semi-structured interviews. Participants, particularly those who were postmenopausal, reported high average scores on depressed mood, memory/concentration, sleep problems, vasomotor symptoms, and sexual behavior subscales of the Women's Health Questionnaire (WHQ). Women reported that poor working environment and work policies and conditions, functioning as sources of work stress, aggravated their menopausal symptoms. Disclosure of their menopausal status was uncommon; limited time and socio-cultural barriers were the most commonly reported reasons for non-disclosure. It could be concluded that the menopause transition is an important occupational health issue especially for women in developing countries. Implementing health promotion programs, improving working environment and work policies, and raising awareness of menopause are recommended to help women to cope with the menopause transition and to maintain well-being and productivity at work. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

The role of oxidative stress in the pathophysiology of hypertension.

PubMed

Rodrigo, Ramón; González, Jaime; Paoletto, Fabio

2011-04-01

Hypertension is considered to be the most important risk factor in the development of cardiovascular disease. An increasing body of evidence suggests that oxidative stress, which results in an excessive generation of reactive oxygen species (ROS), has a key role in the pathogenesis of hypertension. The modulation of the vasomotor system involves ROS as mediators of vasoconstriction induced by angiotensin II, endothelin-1 and urotensin-II, among others. The bioavailability of nitric oxide (NO), which is a major vasodilator, is highly dependent on the redox status. Under physiological conditions, low concentrations of intracellular ROS have an important role in the normal redox signaling maintaining vascular function and integrity. However, under pathophysiological conditions, increased levels of ROS contribute to vascular dysfunction and remodeling through oxidative damage. In human hypertension, an increase in the production of superoxide anions and hydrogen peroxide, a decrease in NO synthesis and a reduction in antioxidant bioavailability have been observed. In turn, antioxidants are reducing agents that can neutralize these oxidative and otherwise damaging biomolecules. The use of antioxidant vitamins, such as vitamins C and E, has gained considerable interest as protecting agents against vascular endothelial damage. Available data support the role of these vitamins as effective antioxidants that can counteract ROS effects. This review discusses the mechanisms involved in ROS generation, the role of oxidative stress in the pathogenesis of vascular damage in hypertension, and the possible therapeutic strategies that could prevent or treat this disorder.

Peroxynitrite Disrupts Endothelial Caveolae Leading to eNOS Uncoupling and Diminished Flow-Mediated Dilation in Coronary Arterioles of Diabetic Patients

PubMed Central

Cassuto, James; Dou, Huijuan; Czikora, Istvan; Szabo, Andras; Patel, Vijay S.; Kamath, Vinayak; Belin de Chantemele, Eric; Feher, Attila; Romero, Maritza J.; Bagi, Zsolt

2014-01-01

Peroxynitrite (ONOO−) contributes to coronary microvascular dysfunction in diabetes mellitus (DM). We hypothesized that in DM, ONOO− interferes with the function of coronary endothelial caveolae, which plays an important role in nitric oxide (NO)-dependent vasomotor regulation. Flow-mediated dilation (FMD) of coronary arterioles was investigated in DM (n = 41) and non-DM (n = 37) patients undergoing heart surgery. NO-mediated coronary FMD was significantly reduced in DM patients, which was restored by ONOO− scavenger, iron-(III)-tetrakis(N-methyl-4'pyridyl)porphyrin-pentachloride, or uric acid, whereas exogenous ONOO− reduced FMD in non-DM subjects. Immunoelectron microscopy demonstrated an increased 3-nitrotyrosine formation (ONOO−-specific protein nitration) in endothelial plasma membrane in DM, which colocalized with caveolin-1 (Cav-1), the key structural protein of caveolae. The membrane-localized Cav-1 was significantly reduced in DM and also in high glucose–exposed coronary endothelial cells. We also found that DM patients exhibited a decreased number of endothelial caveolae, whereas exogenous ONOO− reduced caveolae number. Correspondingly, pharmacological (methyl-β-cyclodextrin) or genetic disruption of caveolae (Cav-1 knockout mice) abolished coronary FMD, which was rescued by sepiapterin, the stable precursor of NO synthase (NOS) cofactor, tetrahydrobiopterin. Sepiapterin also restored coronary FMD in DM patients. Thus, we propose that ONOO− selectively targets and disrupts endothelial caveolae, which contributes to NOS uncoupling, and, hence, reduced NO-mediated coronary vasodilation in DM patients. PMID:24353182

Bidirectional Control of Blood Flow by Astrocytes: A Role for Tissue Oxygen and Other Metabolic Factors.

PubMed

Gordon, Grant R J; Howarth, Clare; MacVicar, Brian A

2016-01-01

Altering cerebral blood flow through the control of cerebral vessel diameter is critical so that the delivery of molecules important for proper brain functioning is matched to the activity level of neurons. Although the close relationship of brain glia known as astrocytes with cerebral blood vessels has long been recognized, it is only recently that these cells have been demonstrated to translate information on the activity level and energy demands of neurons to the vasculature. In particular, astrocytes respond to elevations in extracellular glutamate as a consequence of synaptic transmission through the activation of group 1 metabotropic glutamate receptors. These Gq-protein coupled receptors elevate intracellular calcium via IP3 signaling. A close examination of astrocyte endfeet calcium signals has been shown to cause either vasoconstriction or vasodilation. Common to both vasomotor responses is the generation of arachidonic acid in astrocytes by calcium sensitive phospholipase A2. Vasoconstriction ensues from the conversion of arachidonic acid to 20-hydroxyeicosatetraenoic acid, while vasodilation ensues from the production of epoxyeicosatrienoic acids or prostaglandins. Factors that determine whether constrictor or dilatory pathways predominate include brain oxygen, lactate, adenosine as well as nitric oxide. Changing the oxygen level itself leads to many downstream changes that facilitate the switch from vasoconstriction at high oxygen to vasodilation at low oxygen. These findings highlight the importance of astrocytes as sensors of neural activity and metabolism to coordinate the delivery of essential nutrients via the blood to the working cells.

Endothelial CaMKII as a regulator of eNOS activity and NO-mediated vasoreactivity

PubMed Central

Murthy, Shubha; Koval, Olha M.; Ramiro Diaz, Juan M.; Kumar, Santosh; Nuno, Daniel; Scott, Jason A.; Allamargot, Chantal; Zhu, Linda J.; Broadhurst, Kim; Santhana, Velarchana; Kutschke, William J.; Irani, Kaikobad; Lamping, Kathryn G.; Grumbach, Isabella M.

2017-01-01

The multifunctional Ca2+/calmodulin-dependent protein kinase II (CaMKII) is a serine/threonine kinase important in transducing intracellular Ca2+ signals. While in vitro data regarding the role of CaMKII in the regulation of endothelial nitric oxide synthase (eNOS) are contradictory, its role in endothelial function in vivo remains unknown. Using two novel transgenic models to express CaMKII inhibitor peptides selectively in endothelium, we examined the effect of CaMKII on eNOS activation, NO production, vasomotor tone and blood pressure. Under baseline conditions, CaMKII activation was low in the aortic wall. Consistently, systolic and diastolic blood pressure, heart rate and plasma NO levels were unaltered by endothelial CaMKII inhibition. Moreover, endothelial CaMKII inhibition had no significant effect on NO-dependent vasodilation. These results were confirmed in studies of aortic rings transduced with adenovirus expressing a CaMKII inhibitor peptide. In cultured endothelial cells, bradykinin treatment produced the anticipated rapid influx of Ca2+ and transient CaMKII and eNOS activation, whereas CaMKII inhibition blocked eNOS phosphorylation on Ser-1179 and dephosphorylation at Thr-497. Ca2+/CaM binding to eNOS and resultant NO production in vitro were decreased under CaMKII inhibition. Our results demonstrate that CaMKII plays an important role in transient bradykinin-driven eNOS activation in vitro, but does not regulate NO production, vasorelaxation or blood pressure in vivo under baseline conditions. PMID:29059213

Effects of flaxseed and Hypericum perforatum on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women: a systematic review and meta-analysis

PubMed Central

Ghazanfarpour, Masumeh; Sadeghi, Ramin; Latifnejad Roudsari, Robab; Khadivzadeh, Talat; khorsand, Imaneh; Afiat, Maliheh; Esmaeilizadeh, Mahdi

2016-01-01

Objective: In this study, we aimed at evaluation of the efficacy of Hypericum perforatum and flaxseed on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women Materials and Methods: We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (RCT) to explore trials that assessed the effectiveness of H. perforatum and flaxseed on hot flash, vaginal atrophy and estrogen-dependent cancers. In this regard, the following terms were used “menopause AND H. perforatum OR flaxseed OR Linum usitatissimum. Only randomized controlled trials were included in the study. Results: Nine RCTs were included in this systematic review. Based on the literature, flaxseed showed beneficial effect on hot flash frequency and intensity, which was not statistically significant. According to two trials, flaxseed showed estrogenic effects; however, no conclusion regarding cancer promoting or protecting effects can be made. The evidence of the efficacy of the flaxseed on alleviating vaginal atrophy was also limited due to inconsistent findings in this regard. One trial declared that Vitex agnus-castus and H. perforatum showed comparable decrease in the frequency of hot flashes. Conclusion: The results of our systematic review suggest beneficial effect on vasomotor symptom with both of flaxseed and H. perforatum. Consistent conclusion regarding estrogen-dependent cancers and maturation value is limited due to small number of trials related to flaxseed. Further trials are still needed to confirm the results of our systematic review. PMID:27462550

Arteriolar vasomotor control and contractile performance during fatiguing tetanic contractions in rat skeletal muscle: role of sympathetic system.

PubMed

Inagaki, Tadakatsu; Sonobe, Takashi; Poole, David C; Kano, Yutaka

2010-01-01

Using a fatiguing stimulation protocol designed specifically to enhance sympathetically-mediated vasoconstrictor tone, we explored the temporal profile of the evoked vasoconstrictor response, evaluated the presence of sympatholysis, and assessed the role of alpha1-adrenergic receptor-mediated vasoconstriction on muscle performance. Spinotrapezius muscles of Wistar rats were exteriorized and stimulated tetanically (100 Hz, 4-7 V, stimulus duration 700 ms) every 3 s for 2.5 min under control and prazosin (1 muM) superfused conditions. The extent and time course of diameter changes in arterioles (2 A) and venules (2 V) were determined after each of 10 discrete sets of muscle stimulation at 5-min intervals. A significant decrease of luminal diameter was observed in arterioles after tetanic contractions at 8-10 sets (8 sets: -34.4%, 9 sets: -39.4%, 10 sets: -38.6% vs pre-contraction at each set, p < 0.01). Prazosin significantly reduced but did not abolish the contraction-induced vasoconstriction. In both conditions, there was no reduction of venules diameter observed. Tetanic contractions force at the final 10th set was significantly decreased to 29.3 +/- 11.9% from pre-fatigue conditions, while tetanic contractions with prazosin force production was maintained at 70.4 +/- 14.2% at the 10th set. We conclude that in sequential bouts of contractions there was a progressively greater degree of arteriolar (but not venular) vasoconstriction which was attenuated substantially by prazosin.

Effects of flaxseed and Hypericum perforatum on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women: a systematic review and meta-analysis.

PubMed

Ghazanfarpour, Masumeh; Sadeghi, Ramin; Latifnejad Roudsari, Robab; Khadivzadeh, Talat; Khorsand, Imaneh; Afiat, Maliheh; Esmaeilizadeh, Mahdi

2016-01-01

In this study, we aimed at evaluation of the efficacy of Hypericum perforatum and flaxseed on hot flash, vaginal atrophy and estrogen-dependent cancers in menopausal women. We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (RCT) to explore trials that assessed the effectiveness of H. perforatum and flaxseed on hot flash, vaginal atrophy and estrogen-dependent cancers. In this regard, the following terms were used "menopause AND H. perforatum OR flaxseed OR Linum usitatissimum. Only randomized controlled trials were included in the study. Nine RCTs were included in this systematic review. Based on the literature, flaxseed showed beneficial effect on hot flash frequency and intensity, which was not statistically significant. According to two trials, flaxseed showed estrogenic effects; however, no conclusion regarding cancer promoting or protecting effects can be made. The evidence of the efficacy of the flaxseed on alleviating vaginal atrophy was also limited due to inconsistent findings in this regard. One trial declared that Vitex agnus-castus and H. perforatum showed comparable decrease in the frequency of hot flashes. The results of our systematic review suggest beneficial effect on vasomotor symptom with both of flaxseed and H. perforatum. Consistent conclusion regarding estrogen-dependent cancers and maturation value is limited due to small number of trials related to flaxseed. Further trials are still needed to confirm the results of our systematic review.

Measurement of pulmonary arterial impedance and reflection from single-slice phase-contrast and steady-state free precession MRI

NASA Astrophysics Data System (ADS)

Leimbigler, Peter John

Pulmonary arterial hypertension (PAH) alters vessel wall mechanics and vasomotor tone, driving up pulmonary hemodynamic variables such as pulse wave velocity, input and characteristic impedance, and pulse wave reflection magnitude. Heterogeneous treatment response necessitates frequent hemodynamic evaluation, for which right-heart catheterization (RHC) remains the gold standard; however, several disadvantages limit its frequency of use. In this work, a non-invasive magnetic resonance (MR) imaging protocol is developed to address the shortcomings of invasive hemodynamic monitoring and may support existing diagnostic procedures. First, accuracy and precision of the proposed method is characterized through linear uncertainty propagation and numerical simulation of the data-processing pipeline. Second, the MR protocol is tested in seven healthy adult volunteers. Third, a rapid version of the MR protocol is tested in a healthy volunteer, yielding good agreement with mean values obtained in the seven-volunteer study.

Effectiveness of Traditional Chinese Acupuncture versus Sham Acupuncture: a Systematic Review

PubMed Central

Carlos, Luís; da Cruz, Lóris Aparecida Prado; Leopoldo, Vanessa Cristina; de Campos, Fabrício Ribeiro; de Almeida, Ana Maria; Silveira, Renata Cristina de Campos Pereira

2016-01-01

ABSTRACT Objective: to identify and synthesize the evidence from randomized clinical trials that tested the effectiveness of traditional Chinese acupuncture in relation to sham acupuncture for the treatment of hot flashes in menopausal women with breast cancer. Method: systematic review guided by the recommendations of the Cochrane Collaboration. Citations were searched in the following databases: MEDLINE via PubMed, Web of Science, CENTRAL, CINAHL, and LILACS. A combination of the following keywords was used: breast neoplasm, acupuncture, acupuncture therapy, acupuncture points, placebos, sham treatment, hot flashes, hot flushes, menopause, climacteric, and vasomotor symptoms. Results: a total of 272 studies were identified, five of which were selected and analyzed. Slight superiority of traditional acupuncture compared with sham acupuncture was observed; however, there were no strong statistical associations. Conclusions: the evidence gathered was not sufficient to affirm the effectiveness of traditional acupuncture compared with sham acupuncture. PMID:27533271

[Diagnosis and treatment of polycythaemia vera: state of the art].

PubMed

Marton, Imelda; Simon, Zsófia; Borbényi, Zita

2016-10-01

Polycythaemia vera (PV), a condition characterized by blood hyperviscosity due to the expansion of the erythrocyte mass is the most common entity among all Philadelphia chromosome-negative myeloproliferative neoplasms. Arterial and venous thrombotic events are leading determinants of morbidity and mortality but impairment of quality of life due to vasomotor symptoms (erythromelalgia, pruritus) and disease-associated symptoms (tiredness, fatigue, pruritus, night sweats, vision problems, headache, concentration loss, abdominal discomfort, early satiety, fever, weight loss) are also present. The review of polycythaemia vera is actual as the updated WHO 2016 classification of myeloid neoplasms has changed the diagnostic criteria and a new second-line treatment option - JAK1/JAK2 inhibitor ruxolitinib - has been approved for patients who had an inadequate response to or are intolerant of hydroxyurea, which represents a breakthrough in the treatment of this patient population. Orv. Hetil., 2016, 157(44), 1743-1751.

[Phalloplethysmographic findings in homosexual pedophile offenders].

PubMed

Tichý, P

1991-03-29

Using phalloplethysmographic tests comprising 20 coloured slides of four categories the authors examined 50 homosexual pedophil delinquents and a matched group of heterosexual men. The findings of the two compared groups differed significantly on exposure to three categories of erotic stimuli--adult heterosexual and homosexual objects and child homosexual objects. Only on projection of child heterosexual objects there were no statistically significant differences in the number and magnitude of positive vasomotor reactions recorded in the two groups. Men in the control group responded more frequently and more positively to adult heterosexual objects than homosexual pedophil delinquents. The latter responded more frequently positively to adult and child homosexual objects. In more than one quarter of the delinquents (13 men) a preference of child objects was found, i.e. a deviant pedophil orientation. In seven men the preference of child objects was without sexual differentiation, six men preferred homosexual child objects.

Balance of autonomic nervous system in children having signs of endothelial dysfunction, that were born and are domiciled in contaminated territories.

PubMed

Kondrashova, V G; Kolpakov, I E; Vdovenko, V Yu; Leonovych, O S; Lytvynets, O M; Stepanova, E I

2014-09-01

Objective. The study examined the features of functional state of the autonomic nervous system in children having endothelial dysfunction and permanently residing in contaminated areas. Materials and methods. Clinical and instrumental examination of 101 children aged 7-18 years that were born and are domiciled in contaminated territories, including 37 persons with signs of endothelial dysfunction (subgroup IA) and 64 ones with no signs of endothelial dysfunction (IB subgroup) was conducted. The control group being comparable to the subgroups IA and IB by age, gender and clinical examination results included 37 children neither been domiciled in contaminated areas nor were belonging to the contingent of Chornobyl accident survivors. There were 20 apparently healthy children also examined. Results. Due to peculiarities of physiological pathways providing adaptive responses the children having signs of endothelial dysfunction are characterized by a more pronounced dysregulation of autonomous nervous system both in a resting state and under a functional load simulation, and also by a high strain of adaptation pathways. The lack of autonomous support of cardiovascular system is caused by inadequate adaptive responses of both central regulatory bodies (hypothalamus, vasomotor center) and peripheral receptors. Mainly the failure of segmental autonomous (parasympathetic) structures was revealed. The mode of their response to stress in this case corresponds to that in healthy individuals but at a lower functional level. There is a reduced aerobic capacity of the organism by the Robinson index, contributing to low adaptive range to non-specific stress in children being domiciled on contaminated territories including children having the endothelial dysfunction. Conclusions. Endothelial dysfunction was associated with more pronounced manifestations of autonomic dysregulation and reduced aerobic capacity of the organism being the risk factors of development of a range of somatic diseases requiring the development of prevention measures in children permanently residing in contaminated areas. autonomous nervous system balance, endothelial dysfunction, children, Chornobyl accident. V. G. Kondrashova, I. E. Kolpakov, V. Yu. Vdovenko, O. S. Leonovych, O. M. Lytvynets, E. I. Stepanova.

Effect of head-down-tilt bed rest and hypovolemia on dynamic regulation of heart rate and blood pressure

NASA Technical Reports Server (NTRS)

Iwasaki, K. I.; Zhang, R.; Zuckerman, J. H.; Pawelczyk, J. A.; Levine, B. D.; Blomqvist, C. G. (Principal Investigator)

2000-01-01

Adaptation to head-down-tilt bed rest leads to an apparent abnormality of baroreflex regulation of cardiac period. We hypothesized that this "deconditioning response" could primarily be a result of hypovolemia, rather than a unique adaptation of the autonomic nervous system to bed rest. To test this hypothesis, nine healthy subjects underwent 2 wk of -6 degrees head-down bed rest. One year later, five of these same subjects underwent acute hypovolemia with furosemide to produce the same reductions in plasma volume observed after bed rest. We took advantage of power spectral and transfer function analysis to examine the dynamic relationship between blood pressure (BP) and R-R interval. We found that 1) there were no significant differences between these two interventions with respect to changes in numerous cardiovascular indices, including cardiac filling pressures, arterial pressure, cardiac output, or stroke volume; 2) normalized high-frequency (0.15-0.25 Hz) power of R-R interval variability decreased significantly after both conditions, consistent with similar degrees of vagal withdrawal; 3) transfer function gain (BP to R-R interval), used as an index of arterial-cardiac baroreflex sensitivity, decreased significantly to a similar extent after both conditions in the high-frequency range; the gain also decreased similarly when expressed as BP to heart rate x stroke volume, which provides an index of the ability of the baroreflex to alter BP by modifying systemic flow; and 4) however, the low-frequency (0.05-0.15 Hz) power of systolic BP variability decreased after bed rest (-22%) compared with an increase (+155%) after acute hypovolemia, suggesting a differential response for the regulation of vascular resistance (interaction, P < 0.05). The similarity of changes in the reflex control of the circulation under both conditions is consistent with the hypothesis that reductions in plasma volume may be largely responsible for the observed changes in cardiac baroreflex control after bed rest. However, changes in vasomotor function associated with these two conditions may be different and may suggest a cardiovascular remodeling after bed rest.

Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society.

PubMed

2015-11-01

To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS. NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees. Nonhormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman's personal choice. Nonhormonal therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making. Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.

Depressive disorders and the menopause transition.

PubMed

Llaneza, Plácido; García-Portilla, María P; Llaneza-Suárez, David; Armott, Begoña; Pérez-López, Faustino R

2012-02-01

Depressive disorders and symptoms are common among middle-aged women. The effects of hormones on depression remain unclear. This review aims to clarify the nature of depressive disorders during the menopause transition as well as their links with climacteric syndrome, sexuality, cardiovascular risk and cognitive function. The recent literature on depressive disorders and menopause is reviewed. Women are more vulnerable than men to depressive disorders. Endocrine influences have been postulated but differences in, for example, coping style and response to stress may also contribute to the gender difference in the prevalence of depressive disorders. Gender differences in socialization may lead to higher rates of depression in women. There are data top suggest that menopause and depression are associated, although there is not a common clear causative factor. Women with climacteric symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) are more likely to report anxiety and/or depressive symptoms. Bothersome vasomotor symptoms could be associated with sleep disturbances, which in turn can increase reports of anxiety and depressive symptoms. Biopsychosocial and partner factors have a significant influence on middle-aged women's sexuality and depressive disorders, and most antidepressants can have a negative effect on sexual response. Lastly, studies have consistently shown that women with high levels of depressive symptoms are at greater cardiovascular risk and have poorer cognitive function than non-depressed women. At present, a direct relationship between psychiatric symptoms and hormonal changes such as estrogen decrease has not been clearly found. Stress, educational level, ethnicity, socioeconomic factors and partner status may influence the prevalence and clinical course of both menopause symptoms and depressive disorders. Since in many cases depression is a lifelong condition, and is associated with severe comorbid conditions, further studies are needed to improve the early diagnosis of depression; it may be advisable to monitor a woman's mental health during the menopause transition to prevent a depressive disorder having long-term negative consequences. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Mechanism of blood pressure and R-R variability: insights from ganglion blockade in humans

NASA Technical Reports Server (NTRS)

Zhang, Rong; Iwasaki, Kenichi; Zuckerman, Julie H.; Behbehani, Khosrow; Crandall, Craig G.; Levine, Benjamin D.; Blomqvist, C. G. (Principal Investigator)

2002-01-01

Spontaneous blood pressure (BP) and R-R variability are used frequently as 'windows' into cardiovascular control mechanisms. However, the origin of these rhythmic fluctuations is not completely understood. In this study, with ganglion blockade, we evaluated the role of autonomic neural activity versus other 'non-neural' factors in the origin of BP and R-R variability in humans. Beat-to-beat BP, R-R interval and respiratory excursions were recorded in ten healthy subjects (aged 30 +/- 6 years) before and after ganglion blockade with trimethaphan. The spectral power of these variables was calculated in the very low (0.0078-0.05 Hz), low (0.05-0.15 Hz) and high (0.15-0.35 Hz) frequency ranges. The relationship between systolic BP and R-R variability was examined by cross-spectral analysis. After blockade, R-R variability was virtually abolished at all frequencies; however, respiration and high frequency BP variability remained unchanged. Very low and low frequency BP variability was reduced substantially by 84 and 69 %, respectively, but still persisted. Transfer function gain between systolic BP and R-R interval variability decreased by 92 and 88 % at low and high frequencies, respectively, while the phase changed from negative to positive values at the high frequencies. These data suggest that under supine resting conditions with spontaneous breathing: (1) R-R variability at all measured frequencies is predominantly controlled by autonomic neural activity; (2) BP variability at high frequencies (> 0.15 Hz) is mediated largely, if not exclusively, by mechanical effects of respiration on intrathoracic pressure and/or cardiac filling; (3) BP variability at very low and low frequencies (< 0.15 Hz) is probably mediated by both sympathetic nerve activity and intrinsic vasomotor rhythmicity; and (4) the dynamic relationship between BP and R-R variability as quantified by transfer function analysis is determined predominantly by autonomic neural activity rather than other, non-neural factors.

Vasoresponsiveness of collateral vessels in the rat hindlimb: influence of training.

PubMed

Colleran, Patrick N; Li, Zeyi; Yang, Hsiao T; Laughlin, M Harold; Terjung, Ronald L

2010-04-15

Exercise training is known to be an effective means of improving functional capacity and quality of life in patients with peripheral arterial insufficiency (PAI). However, the specific training-induced physiological adaptations occurring within collateral vessels remain to be clearly defined. The purpose of this study was to determine the effect of exercise training on vasomotor properties of isolated peripheral collateral arteries. We hypothesized that daily treadmill exercise would improve the poor vasodilatory capacity of collateral arteries isolated from rats exposed to surgical occlusion of the femoral artery. Following femoral artery ligation, animals were either kept sedentary or exercise trained daily for a period of 3 weeks. Hindlimb collateral arteries were then isolated, cannulated and pressurized via hydrostatic reservoirs to an intravascular pressure of either 45 or 120 cmH(2)O. Non-occluded contralateral vessels of the sedentary animals served as normal Control. Vasodilatory responses to acetylcholine (ACh; 1 x 10(9)-1 x 10(5)m) and sodium nitroprusside (SNP; 1 x 10(9)-1 x 10(4)m), constrictor responses to phenylephrine (PE; 1 x 10(9)-1 x 10(4)m), and flow-induced vasodilatation were determined. Endothelium-mediated vasodilatation responses were significantly greater to either ACh (P < 0.02) or intravascular flow (P < 0.001) in collateral arteries of trained rats. Neither blockade of cyclooxygenase with indomethacin (Indo; 5 microm) nor blockade of endothelial nitric oxide synthase with N(G)-nitro-L-arginine methyl ester (L-NAME; 300 microm) eliminated this ACh- or flow-induced vasodilatation. The depressed vasodilatory response to SNP caused by vascular occlusion was reversed with training. These data indicate that exercise training improves endothelium-mediated vasodilatory capacity of hindlimb collateral arteries, apparently by enhanced production of the putative endothelium-derived hyperpolarizing factor(s). If these findings were applicable to patients with PAI, they could contribute to an improved collateral vessel function and enhance exercise tolerance during routine physical activity.

Crosstalk between the angiotensin and endothelin system in the cerebrovasculature after experimental induced subarachnoid hemorrhage.

PubMed

Wanderer, Stefan; Mrosek, Jan; Vatter, Hartmut; Seifert, Volker; Konczalla, Juergen

2018-04-01

Under physiologic conditions, losartan showed a dose-dependent antagonistic effect to the endothelin-1 (ET-1)-mediated vasoconstriction. This reduced vasoconstriction was abolished after preincubation with an endothelin B 1 receptor (ET(B 1 )-receptor) antagonist. Also, an increased ET(B 1 )-receptor-dependent relaxation to sarafotoxin S6c (S6c; an ET(B 1 )-receptor agonist) was detected by preincubation with losartan. Investigations after experimental induced subarachnoid hemorrhage (SAH) are still missing. Therefore, we analyzed losartan in a further pathological setup. Cerebral vasospasm was induced by a modified double hemorrhage model. Rats were sacrificed on day 3 and isometric force of basilar artery ring segments was measured. Parallel to physiological conditions, after SAH, the ET-1-induced vasoconstriction was decreased by preincubation with losartan. This reduced contraction has been abolished after preincubation with BQ-788, an ET(B 1 )-receptor antagonist. In precontracted vessels, ET-1 induced a higher vasorelaxation under losartan and the endothelin A receptor (ET(A)-receptor) antagonist BQ-123. After SAH, losartan caused a modulatory effect on the ET(B 1 )-receptor-dependent vasorelaxation. It further induced an upregulation of the NO pathway. Under losartan, the formerly known loss of the ET(B 1 )-receptor vasomotor function was abolished and a significantly increased relaxation, accompanied with an enhanced sensitivity of the ET(B 1 )-receptor, has been detected. Also, the dose-dependent antagonistic effect to the ET-1-induced contraction can be effected by angiotensin II type 1 receptor (AT 1 -receptor) antagonism due to losartan directly via the ET(B 1 )-receptor.

Evidence of small-fiber polyneuropathy in unexplained, juvenile-onset, widespread pain syndromes.

PubMed

Oaklander, Anne Louise; Klein, Max M

2013-04-01

We tested the hypothesis that acquired small-fiber polyneuropathy (SFPN), previously uncharacterized in children, contributes to unexplained pediatric widespread pain syndromes. Forty-one consecutive patients evaluated for unexplained widespread pain beginning before age 21 had medical records comprehensively analyzed regarding objective diagnostic testing for SFPN (neurodiagnostic skin biopsy, nerve biopsy, and autonomic function testing), plus histories, symptoms, signs, other tests, and treatments. Healthy, demographically matched volunteers provided normal controls for SFPN tests. Age at illness onset averaged 12.3 ± 5.7 years; 73% among this poly-ethnic sample were female (P = .001). Sixty-eight percent were chronically disabled, and 68% had hospitalizations. Objective testing diagnosed definite SFPN in 59%, probable SFPN in 17%, and possible SFPN in 22%. Only 1 of 41 had entirely normal SFPN test results. Ninety-eight percent of patients had other somatic complaints consistent with SFPN dysautonomia (90% cardiovascular, 82% gastrointestinal, and 34% urologic), 83% reported chronic fatigue, and 63% had chronic headache. Neurologic examinations identified reduced sensation in 68% and vasomotor abnormalities in 55%, including 23% with erythromelalgia. Exhaustive investigations for SFPN causality identified only history of autoimmune illnesses in 33% and serologic markers of disordered immunity in 89%. Treatment with corticosteroids and/or intravenous immune globulin objectively and subjectively benefited 80% of patients (12/15). More than half among a large series of patients with childhood-onset, unexplained chronic widespread pain met rigorous, multitest, diagnostic criteria for SFPN, which extends the age range of acquired SFPN into early childhood. Some cases appeared immune-mediated and improved with immunomodulatory therapies.

Closed-loop regulation of arterial pressure after acute brain death.

PubMed

Soltesz, Kristian; Sjöberg, Trygve; Jansson, Tomas; Johansson, Rolf; Robertsson, Anders; Paskevicius, Audrius; Liao, Quiming; Qin, Guangqi; Steen, Stig

2018-06-01

The purpose of this concept study was to investigate the possibility of automatic mean arterial pressure (MAP) regulation in a porcine heart-beating brain death (BD) model. Hemodynamic stability of BD donors is necessary for maintaining acceptable quality of donated organs for transplantation. Manual stabilization is challenging, due to the lack of vasomotor function in BD donors. Closed-loop stabilization therefore has the potential of increasing availability of acceptable donor organs, and serves to indicate feasibility within less demanding patient groups. A dynamic model of nitroglycerine pharmacology, suitable for controller synthesis, was identified from an experiment involving an anesthetized pig, using a gradient-based output error method. The model was used to synthesize a robust PID controller for hypertension prevention, evaluated in a second experiment, on a second, brain dead, pig. Hypotension was simultaneously prevented using closed-loop controlled infusion of noradrenaline, by means of a previously published controller. A linear model of low order, with variable (uncertain) gain, was sufficient to describe the dynamics to be controlled. The robustly tuned PID controller utilized in the second experiment kept the MAP within a user-defined range. The system was able to prevent hypertension, exceeding a reference of 100 mmHg by more than 10%, during 98% of a 12 h experiment. This early work demonstrates feasibility of the investigated modelling and control synthesis approach, for the purpose of maintaining normotension in a porcine BD model. There remains a need to characterize individual variability, in order to ensure robust performance over the expected population.

Temporal prolongation of decreased skin blood flow causes cold limbs in Parkinson's disease.

PubMed

Shindo, Kazumasa; Kobayashi, Fumikazu; Miwa, Michiaki; Nagasaka, Takamura; Takiyama, Yoshihisa; Shiozawa, Zenji

2013-03-01

To unravel the pathogenesis of cold limbs in Parkinson's disease, we evaluated cutaneous vasomotor neural function in 25 Parkinson's disease patients with or without cold limbs and 20 healthy controls. We measured resting skin sympathetic nerve activity, as well as reflex changes of skin blood flow and skin sympathetic nerve activity after electrical stimulation, with the parameters including skin sympathetic nerve activity frequency at rest, the amplitude of reflex bursts, the absolute decrease and percent reduction of blood flow, and the recovery time which was calculated as the interval from the start of blood flow reduction until the return to baseline cutaneous blood flow. The resting frequency of skin sympathetic nerve activity was significantly lower in patients with Parkinson's disease than in controls (p < 0.01). There were no significant differences between the patients and controls with respect to the amplitude of skin sympathetic nerve activity and the absolute decrease or percent reduction of blood flow volume. In the controls, the recovery time (9.4 ± 1.2), which was similar to Parkinson's disease patients without cold limbs (9.0 ± 0.7), while the recovery time ranged (15.7 ± 3.2) in Parkinson's disease patients with cold limbs. Recovery was significantly slower in these patients compared with the other groups (p < 0.05). It is possible that cold limbs might arise due to impaired circulation based on prolonged vasoconstriction by peripheral autonomic impairments, in addition to central autonomic dysfunction in Parkinson's disease.

Gene transfer of extracellular superoxide dismutase reduces arterial pressure in spontaneously hypertensive rats: role of heparin-binding domain.

PubMed

Chu, Yi; Iida, Shinichiro; Lund, Donald D; Weiss, Robert M; DiBona, Gerald F; Watanabe, Yoshimasa; Faraci, Frank M; Heistad, Donald D

2003-03-07

Oxidative stress may contribute to hypertension. The goals of this study were to determine whether extracellular superoxide dismutase (ECSOD) reduces arterial pressure in spontaneously hypertensive rats (SHR) and whether its heparin-binding domain (HBD), which is responsible for cellular binding, is necessary for the function of ECSOD. Three days after intravenous injection of an adenoviral vector expressing human ECSOD (AdECSOD), mean arterial pressure (MAP) decreased from 165+/-4 mm Hg (mean+/-SE, n=7) to 124+/-3 mm Hg (n=7) in adult anesthetized SHR (P<0.01) but was not altered in normotensive Wistar-Kyoto rats. Cardiac output was not changed in SHR 3 days after AdECSOD. Gene transfer of ECSOD with deletion of the HBD (AdECSODDeltaHBD) had no effect on SHR MAP, even though plasma SOD activity was greater after AdECSODDeltaHBD than after AdECSOD. Immunohistochemistry revealed intense staining for ECSOD in blood vessels and kidneys after AdECSOD but not after AdECSODDeltaHBD. Impaired relaxation of the carotid artery to acetylcholine in SHR was significantly improved after AdECSOD. Cumulative sodium balance in SHR was reduced by AdECSOD compared with AdECSODDeltaHBD. Gene transfer of ECSOD also reduced MAP in conscious SHR, although the effect was not as profound as in anesthetized SHR. In summary, gene transfer of ECSOD, with a strict requirement for its HBD, reduces systemic vascular resistance and arterial pressure in a genetic model of hypertension. This reduction in arterial pressure may be mediated by vasomotor and/or renal mechanisms.

Evidence of Small-Fiber Polyneuropathy in Unexplained, Juvenile-Onset, Widespread Pain Syndromes

PubMed Central

Klein, Max M.

2013-01-01

OBJECTIVE: We tested the hypothesis that acquired small-fiber polyneuropathy (SFPN), previously uncharacterized in children, contributes to unexplained pediatric widespread pain syndromes. METHODS: Forty-one consecutive patients evaluated for unexplained widespread pain beginning before age 21 had medical records comprehensively analyzed regarding objective diagnostic testing for SFPN (neurodiagnostic skin biopsy, nerve biopsy, and autonomic function testing), plus histories, symptoms, signs, other tests, and treatments. Healthy, demographically matched volunteers provided normal controls for SFPN tests. RESULTS: Age at illness onset averaged 12.3 ± 5.7 years; 73% among this poly-ethnic sample were female (P = .001). Sixty-eight percent were chronically disabled, and 68% had hospitalizations. Objective testing diagnosed definite SFPN in 59%, probable SFPN in 17%, and possible SFPN in 22%. Only 1 of 41 had entirely normal SFPN test results. Ninety-eight percent of patients had other somatic complaints consistent with SFPN dysautonomia (90% cardiovascular, 82% gastrointestinal, and 34% urologic), 83% reported chronic fatigue, and 63% had chronic headache. Neurologic examinations identified reduced sensation in 68% and vasomotor abnormalities in 55%, including 23% with erythromelalgia. Exhaustive investigations for SFPN causality identified only history of autoimmune illnesses in 33% and serologic markers of disordered immunity in 89%. Treatment with corticosteroids and/or intravenous immune globulin objectively and subjectively benefited 80% of patients (12/15). CONCLUSIONS: More than half among a large series of patients with childhood-onset, unexplained chronic widespread pain met rigorous, multitest, diagnostic criteria for SFPN, which extends the age range of acquired SFPN into early childhood. Some cases appeared immune-mediated and improved with immunomodulatory therapies. PMID:23478869

MENOS4 trial: a multicentre randomised controlled trial (RCT) of a breast care nurse delivered cognitive behavioural therapy (CBT) intervention to reduce the impact of hot flushes in women with breast cancer: Study Protocol.

PubMed

Fenlon, Deborah; Nuttall, Jacqueline; May, Carl; Raftery, James; Fields, Jo; Kirkpatrick, Emma; Abab, Julia; Ellis, Mary; Rose, Taylor; Khambhaita, Priya; Galanopoulou, Angeliki; Maishman, Tom; Haviland, Jo; Griffiths, Gareth; Turner, Lesley; Hunter, Myra

2018-05-08

Women who have been treated for breast cancer may identify vasomotor symptoms, such as hot flushes and night sweats (HFNS), as a serious problem. HFNS are unpleasant to experience and can have a significant impact on daily life, potentially leading to reduced adherence to life saving adjuvant hormonal therapy. It is known that Cognitive Behavioural Therapy (CBT) is effective for the alleviation of hot flushes in both well women and women who have had breast cancer. Most women with breast cancer will see a breast care nurse and there is evidence that nurses can be trained to deliver psychological treatments to a satisfactory level, whilst also maintaining treatment fidelity. The research team will assess whether breast care nurses can effectively deliver a CBT intervention to alleviate hot flushes in women with breast cancer. This study is a multi-centre phase III individually randomised controlled trial of group CBT versus usual care to reduce the impact of hot flushes in women with breast cancer. 120-160 women with primary breast cancer experiencing seven or more problematic HFNS a week will be randomised to receive either treatment as usual (TAU) or participation in the group CBT intervention plus TAU (CBT Group). A process evaluation using May's Normalisation Process Theory will be conducted, as well as practical and organisational issues relating to the implementation of the intervention. Fidelity of implementation of the intervention will be conducted by expert assessment. The cost effectiveness of the intervention will also be assessed. There is a need for studies that enable effective interventions to be implemented in practice. There is good evidence that CBT is helpful for women with breast cancer who experience HFNS, yet it is not widely available. It is not yet known whether the intervention can be effectively delivered by breast care nurses or implemented in practice. This study will provide information on both whether the intervention can effectively help women with hot flushes and whether and how it can be translated into routine clinical practice. ISRCTN 12824632 . Registered 25-01-2017.

Effects of a standardised extract of Trifolium pratense (Promensil) at a dosage of 80mg in the treatment of menopausal hot flushes: A systematic review and meta-analysis.

PubMed

Myers, S P; Vigar, V

2017-01-15

To critically assess the evidence for a specific standardised extract of Trifolium pratense isoflavones (Promensil) at a dosage of 80mg/day in the treatment of menopausal hot flushes. Systematic literature searches were performed in Medline, Scopus, CINAHL Plus, Cochrane, AMED and InforRMIT and citations obtained from 1996 to March 2016. Reference lists were checked; corresponding authors contacted and the grey literature searched for additional publications. Studies were selected according to predefined inclusion and exclusion criteria. All randomised clinical trials of a specific standardised extract of Trifolium pratense isoflavones (Promensil) used as a mono-component at 80mg/day and measuring vasomotor symptoms were included. The data extraction and quality assessment were performed independently by one reviewer and validated by a second with any disagreements being settled by discussion. Weighted mean differences and 95% confidence intervals were calculated for continuous data using the fixed-effects model. Twenty potentially relevant papers were identified, with only five studies meeting the inclusion criteria. The meta-analysis demonstrated a statistical and clinically relevant reduction in hot flush frequency in the active treatment group compared to placebo. Weighted mean difference 3.63 hot flushes per day: [95% CI 2.70-4.56]; p˂0.00001). Due to a lack of homogeneity a priori defined sub-group analyses were performed demonstrating a substantive difference between cross-over and parallel-arm clinical trial designs. There is evidence for a statistical and clinically significant benefit for using a specific standardised extract of red clover isoflavones (Promensil) at 80mg/day for treating hot flushes in menopausal women across the 3 studies included in the meta-analysis. The preparation was safe over the short-term duration of the studies (3 months). Copyright © 2016 The Authors. Published by Elsevier GmbH.. All rights reserved.

Menopausal symptoms appear before the menopause and persist 5 years beyond: a detailed analysis of a multinational study.

PubMed

Blümel, J E; Chedraui, P; Baron, G; Belzares, E; Bencosme, A; Calle, A; Danckers, L; Espinoza, M T; Flores, D; Gomez, G; Hernandez-Bueno, J A; Izaguirre, H; Leon-Leon, P; Lima, S; Mezones-Holguin, E; Monterrosa, A; Mostajo, D; Navarro, D; Ojeda, E; Onatra, W; Royer, M; Soto, E; Tserotas, K; Vallejo, M S

2012-12-01

Few Latin American studies have described menopausal symptoms in detail by means of a standardized assessment tool. The objective of this study was to assess the prevalence and severity of menopausal symptoms and their impact over quality of life among mid-aged Latin American women. In this cross-sectional study, 8373 otherwise healthy women aged 40-59 years from 12 Latin American countries were asked to fill out the Menopause Rating Scale (MRS) and a questionnaire containing personal sociodemographic data. Menopause status (pre-, peri- and postmenopausal) was defined according to the criteria of the Stages of Reproductive Aging Workshop. Of all the studied women, 90.9% had at least one menopausal symptom (complaint) that they rated. Muscle and joint discomfort, physical and mental exhaustion and depressive mood were highly prevalent and rated as severe-very severe (scores of 3 and 4), at a higher rate than vasomotor symptoms (15.6%, 13.8% and 13.7% vs. 9.6%, respectively). Of premenopausal women (40-44 years), 77.0% reported at least one rated complaint, with 12.9% displaying MRS scores defined as severe (> 16). The latter rate increased to 26.4% in perimenopausal, 31.6% in early postmenopausal and 29.9% among late postmenopausal women. As measured with the MRS, the presence of hot flushes increased the risk of impairment of overall quality of life in both premenopausal (odds ratio 12.67; 95% confidence interval 9.53-16.83) and peri/postmenopausal women (odds ratio 9.37; 95% confidence interval 7.85-11.19). In this large, mid-aged, female Latin American series, muscle/joint discomfort and psychological symptoms were the most prevalent and severely rated menopausal symptoms. The symptoms appear early in the premenopause, significantly impair quality of life and persist 5 years beyond the menopause.

Genetic susceptibility to renal scar formation after urinary tract infection: a systematic review and meta-analysis of candidate gene polymorphisms.

PubMed

Zaffanello, Marco; Tardivo, Stefano; Cataldi, Luigi; Fanos, Vassilios; Biban, Paolo; Malerba, Giovanni

2011-07-01

Identifying patients who may develop renal scarring after urinary tract infections (UTI) remains challenging, as clinical determinants explain only a portion of individual risk. An additional factor that likely affects risk is individual genetic variability. We searched for peer-reviewed articles from 1980 to December 2009 in electronic databases that reported results showing an association between gene polymorphims and renal scaring after UTI. Two independent researchers screened articles using predetermined criteria. Studies were assessed for methodological quality using an aggregate scoring system. The 18 studies ultimately included in the review had investigated 16 polymorphisms in nine genes in association with renal scarring formation after UTI. Based on the predetermined criteria for assessing the quality of the studies, 12 studies (67%) were identified as being of poor quality design. A meta-analysis of cumulative studies showed on association between renal scarring formation after UTI and the angiotensin converting enzyme insertion/deletion polymorphism [ACE I/D; recessive model for D allele; odds ratio (OR) 1.73, 95% confidence interval (CI) 1.09-2.74, P = 0.02] or transforming growth factor (TGF)-β1 c.-509 T > C polymorphism (dominant model for T allele; OR 2.24, 95% CI 1.34-3.76, P = 0.002). However, heterogeneity among studies was large, indicating a strong difference that cannot only be explained by differences in study design. The studies reviewed in this article support a modest involvement of the vasomotor and inflammatory genes in the development of renal scarring after UTIs. This review also shows that only few possible candidate genes have been investigated for an association with renal scarring, raising the hypothesis that some gene polymorphisms may exert their effects through an interaction with as yet uninvestigated factors that may be related to geographic and/or socio-economic differences.

Menopause in the workplace: What employers should be doing.

PubMed

Jack, Gavin; Riach, Kathleen; Bariola, Emily; Pitts, Marian; Schapper, Jan; Sarrel, Philip

2016-03-01

Large numbers of women transition through menopause whilst in paid employment. Symptoms associated with menopause may cause difficulties for working women, especially if untreated, yet employers are practically silent on this potentially costly issue. This review summarises existing research on the underexplored topic of menopause in the workplace, and synthesises recommendations for employers. Longstanding scholarly interest in the relationship between employment status and symptom reporting typically (but not consistently) shows that women in paid employment (and in specific occupations) report fewer and less severe symptoms than those who are unemployed. Recent studies more systematically focused on the effects of menopausal symptoms on work are typically cross-sectional self-report surveys, with a small number of qualitative studies. Though several papers established that vasomotor (and associated) symptoms have a negative impact on women's productivity, capacity to work and work experience, this is not a uniform finding. Psychological and other somatic symptoms associated with menopause can have a relatively greater negative influence. Physical (e.g., workplace temperature and design) and psychosocial (e.g., work stress, perceptions of control/autonomy) workplace factors have been found to influence the relationship between symptoms and work. Principal recommendations for employers to best support menopausal women as part of a holistic approach to employee health and well-being include risk assessments to make suitable adjustments to the physical and psychosocial work environment, provision of information and support, and training for line managers. Limitations of prior studies, and directions for future research are presented. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effects of venous needle turbulence during ex vivo hemodialysis on endothelial morphology and nitric oxide formation.

PubMed

Huynh, Thanh N; Chacko, Balu K; Teng, Xinjun; Brott, Brigitta C; Allon, Michael; Kelpke, Stacey S; Thompson, John A; Patel, Rakesh P; Anayiotos, Andreas S

2007-01-01

Arteriovenous grafts used for hemodialysis frequently develop intimal hyperplasia (IH), which ultimately leads to graft failure. Although the turbulent jet from the dialysis needle may contribute to vessel wall injury, its role in the pathogenesis of IH is relatively unexplored. In the current study, using bovine aortic endothelial cells (BAEC) cultured on the inner surface of a compliant tube, we evaluated the effects of simulated hemodialysis conditions on morphology and nitric oxide (NO) production. The flows via the graft and needle were 500 ml/min (Reynolds number=819) and 100ml/min (Reynolds number=954), respectively. In the presence of the needle jet for 6h, 19.3% (+/-1.53%) of BAEC were sheared off, whereas no loss of BAEC was observed in the presence of graft flow alone (P<0.05). In the presence of graft flow alone, assessment of cell orientation by the Saltykov method revealed that BAEC were oriented along the flow direction. This alignment, however, was lost in the presence of needle flow. Finally, NO production was also significantly decreased in the presence of the needle flow compared to the presence of graft flow alone (16+/-3.1 vs 34.7+/-1.9 nmol/10(6)cells/h, P<0.05). NO is a key player in vascular homeostasis mechanisms modulating vasomotor tone, inhibiting inflammation and smooth muscle cell proliferation. Thus, the loss of NO signaling and the loss of endothelial integrity caused by needle jet turbulence may contribute to the cascade of events leading to IH formation during hemodialysis.

Sex Hormones, Sleep, and Core Body Temperature in Older Postmenopausal Women

PubMed Central

Murphy, Patricia J.; Campbell, Scott S.

2007-01-01

Study Objectives: Assessment of relationships between polysomnographic sleep, sex hormones, and core body temperature in postmenopausal women. Design and Participants: Ten women aged 57 to 71 years, at least 5 years past menopause. Setting: Laboratory of Human Chronobiology at Weill Cornell Medical College. Interventions: N/A. Measurements and Results: Lower estradiol (E2) and higher luteinizing hormone (LH) levels were significantly correlated with indices of poor sleep quality. Relationships between LH and polysomnographic variables were more robust than those for E2. Significant increases from basal LH levels (i.e., LH pulses) occurred more frequently after sleep onset than prior to sleep onset, and 30 of 32 of these LH pulses occurred prior to long awakenings from sleep. In addition, higher body core temperature prior to and during sleep was significantly correlated with poorer sleep efficiency and higher LH levels. Conclusions: Most investigations of relationships between sleep, sex hormones, and body temperature have focused on perimenopausal women, menopausal phenomena such as hot flashes, the role of declining estrogen, and treatment with exogenous estrogen. The current results suggest that altered levels of both sex steroids and gonadotropins may contribute to sleep disturbance in older women and confirm the results of previous studies indicating that higher body core temperature is associated with poorer sleep quality, even in women without vasomotor symptoms. The findings also raise the possibility of alternate treatment avenues for menopause- and age-related sleep disturbance that focus on altering LH levels. Citation: Murphy PJ; Campbell SS. Sex hormones, sleep, and core body temperature in older postmenopausal women. SLEEP 2007;30(12):1788-1794. PMID:18246988

Women in Free Clinics: An Assessment of Health-Related Quality of Life for Prevention and Health Education.

PubMed

Kamimura, Akiko; Myers, Kyl; Ashby, Jeanie; Trinh, Ha Ngoc; Nourian, Maziar M; Reel, Justine J

2015-08-01

Understanding gender influences on health-related quality of life (HRQoL) is important to improve women's health when considering diseases that afflict women specifically. The target population of this study was uninsured female free clinic patients who are low socio-economic status and lack access to healthcare resources. Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. While approximately half of free clinic patients are women, there is a paucity of comprehensive health-related data for female free clinic patients. US born English, non-US born English, and Spanish speaking female free clinic patients completed a self-administered survey using a standardized women's HRQoL measure in Fall 2014 (N = 389). Female free clinic patients reported lower HRQoL on all aspects of women's health compared to the US baseline scores, and were less likely to utilize preventive care including: mammograms, Pap smear, and HPV vaccination compared to the US general population. Spanish speakers reported a higher percentage of having had mammography and Pap smear, and heard about HPV compared to the other two groups. US born English speakers reported lower levels of HRQoL in vasomotor symptoms and sleep symptoms, and the lowest percentage of breast health and Pap smear screenings compared to non-US born English and Spanish speakers. Non-US born English speakers reported higher preference for female physician compared to US born English speakers and Spanish speakers. Free clinic female patients need preventative interventions and educational opportunities to improve their overall HRQoL.

Effects of body position on thermal, cardiorespiratory and metabolic activity in low birth weight infants.

PubMed

Ammari, Amer; Schulze, Karl F; Ohira-Kist, Kiyoko; Kashyap, Sudha; Fifer, William P; Myers, Michael M; Sahni, Rakesh

2009-08-01

Low birth weight (LBW) infants sleeping prone are known to exhibit many physiological differences from those sleeping supine, including lower energy expenditure (heat production) and higher surface temperature. This apparent increase in heat storage suggests that heat loss may be inhibited in the prone position which, in turn, might influence cardiorespiratory activity. To determine the effects of body position (prone vs. supine) on absolute surface temperature profile (heat storage), central-peripheral (C-P) thermal gradients (vasomotor response), cardiorespiratory activity and metabolic gas exchange in growing LBW infants. Six-hour continuous recordings of absolute surface temperature profiles, cardiorespiratory activity and O2 and CO2 exchange, along with minute-to-minute assessment of behavioral sleep states were performed in 32 healthy growing LBW infants (birth weight 805-1590 g, gestational age 26-35 weeks and postconceptional age at study 33-38 weeks). Each infant was randomly assigned to the prone or supine position for the first 3 h of the study and then reversed for the second 3 h. Surface temperatures were recorded from 4 sites (forehead, flank, forearm and leg) and averaged each minute. Central (forehead and flank)-to-peripheral (forearm and leg) and forehead-to-environment (H-E) thermal gradients were calculated from the surface temperatures. Corresponding sleep states were aligned with minute averages obtained from the temperature and cardiorespiratory measurements. Data were then sorted for prone and supine positions during quiet (QS) and active sleep (AS) and compared using paired t-tests. In the prone position during both AS and QS, infants had higher forehead, flank, forearm and leg surface temperatures, narrower C-P gradients, higher heart rates and respiratory frequency, and lower heart rate and respiratory variability. Despite similar environmental temperatures, the H-E gradient was higher in the prone position. In the prone position infants demonstrated lower O2 consumption and CO2 production and a higher respiratory quotient. Despite thermoregulatory adjustments in cardiorespiratory function, infants sleeping prone have relatively higher body temperature. The cardiorespiratory responses to this modest increase in temperature indicate that thermal and metabolic control of cardiac and respiratory pumps seem to work in opposition. The consequences of any attendant changes in blood gas activity (e.g. hypocapnia and/or increased mixed venous oxygen concentration) due to this override of metabolic control remains speculative.

Why is a prone sleeping position dangerous for certain infants?

PubMed

Byard, Roger W; Bright, Fiona; Vink, Robert

2018-03-01

The prone (face down) sleeping position is known to be associated with a significantly increased risk of sudden and unexpected death in infancy (sudden infant death syndrome or SIDS), however, the reasons for this are unclear. Suggested mechanisms have involved suffocation from occlusion of the external airways by soft bedding/pillows or from flattening of the nose with backward displacement of the tongue, rebreathing of carbon dioxide, blunting of arousal responses with decreased cardiac responses to auditory stimulation, diaphragmatic splinting or fatigue, lowering of vasomotor tone with tachycardia, nasopharyngeal bacterial overgrowth, overheating, alteration of sleep patterns, compromise of cerebral blood flow and upper airway obstruction from distortion of nasal cartilages. Recent studies have, however, shown a significant reduction in substance P in the inferior portion of the olivo-cerebellar complex in SIDS infants which is crucial for the integration of motor and sensory information for the control of head and neck movement. This deficit may explain why some infants are not able to move their faces away from potentially dangerous sleeping environments.

Depression and Heart Diseases: Leading Health Problems.

PubMed

Raič, Matea

2017-12-01

Depression is the most common psychiatric disorder in the world population and the most frequent mental disorder in a primary health care. Unrecognized and untreated depression is associated with a poor outcome of treated chronic diseases which co-exist with depression. Depression and cardiovascular diseases are bidirectional related conditions, risks are for each other, and they often co-exist. Depression is a common disorder in cardiovascular patients with a prevalence of 20% to 45%, which is much more frequent than in the general population. In cardiac patients with acute myocardial infarction, depression occurs three times more often than in the general population. Depression has a direct effect on the pathophysiological changes of various organ systems, changing the values of blood pressure, heart rate, vasomotor tone, vascular resistance, blood viscosity and plasma volume. The potential mechanism for developing heart disease in depressed patients includes hypothalamic-pituitary-adrenal gland dysfunction, increased proinflammatory and prothrombotic factor activity, reduced omega-3 fatty acids, reduced heart rate variability, smoking, physical inactivity, reduced mood, self-esteem and self-efficacy.

Stimulus specificity and individual stereotypy of autonomic responses to motion stressors. M.S. Thesis

NASA Technical Reports Server (NTRS)

Morgan, M. G.

1985-01-01

Motion sickness research shows a lack of agreement regarding the contribution of the autonomic nervous system (ANS). The resolution of this question is exigent for Space Adaptation Syndrome, zero gravity sickness. A case is drawn for the necessity to apply a methodological approach that incorporates: (1) standardization of parameters in relation to the individual differences in variability and prestimulus levels; (2) a concern for patterning of responses; and (3) the physiological association with subjective reports. Vasomotor, heart rate, respiration rate, skin conductance and subjective reports of malaise were collected from 22 subjects while participating in three motion stressors; vertical acceleration, Coriolis stimulation, and combined optokinetic and Coriolis stimulation. The results demonstrate that ANS response patterns can be separated into three mutually exclusive components: (1) a generalized response to motion sickness; (2) a stimulus specific response to the type of stressor being presented; and (3) individualized stereotypical response patterns that are associated with subjective reports of malaise.

Cerebral vasomotor responsiveness to carbon dioxide is preserved during propofol and midazolam anesthesia in humans.

PubMed

Strebel, S; Kaufmann, M; Guardiola, P M; Schaefer, H G

1994-05-01

Carbon dioxide reactivity, as measured by transcranial Doppler ultrasonography, was determined during total intravenous anesthesia with propofol or midazolam in comparison with an awake control group. Thirty ASA physical status I neurosurgical patients undergoing lumbar laminectomy participated in the study. In randomized order they were subjected to a CO2 reactivity challenge, either under an intravenous anesthesia technique or in the awake state. CO2 reactivity was calculated in each study group as a relative change in middle cerebral artery (MCA) flow velocity per mm Hg change in end-tidal CO2 (PETCO2) (%/mm Hg). The cerebrovascular response to changes in CO2 was preserved during intravenous anesthesia. There was a significant difference (P < 0.05) in the reactivity slopes between the awake and the anesthetized patients with a small but not significant difference between the propofol and the midazolam group. We conclude that hypocarbia is effective in reducing cerebral blood flow velocity (CBFV) during intravenous anesthesia, either with propofol or midazolam.

[Variability of heart rhythm in dynamic study of the psychovegetative relationship in neurogenic syncope].

PubMed

Musaeva, Z A; Khaspekova, N B; Veĭn, A M

2001-01-01

Physiological changes accompanying syncopes of neural origin (SNO) in patients with psychovegetative syndrome are still insufficiently studied. The data concerning the role of the autonomic nervous system are discrepant. Heart rate variability was analyzed in 68 patients with SNO in a supine position and during the active 20-min orthostatic test taking into account the heart rate components of very low frequency (VLF, an index of cerebral sympathetic activity) and high frequency (HF, a marker of vagal modulation). Steady growth of the VLF and progressive decrease in the LF within 15-20 min of the orthostasis were observed in all the patients (n = 33), who fainted after this period. The predominance of the VLF in the heart rate power spectra was correlated with a high level of anxiety. It is suggested that this fact indicates the stable cerebral sympathetic activation resulting in a baroreceptor dysfunction, i.e., a failure of vasomotor regulation in patients with SNO.

PAUSE: A Patient-Centric Tool to Support Patient-Provider Engagement on Menopause

PubMed Central

Ashkenazy, Rebecca; Peterson, Mary Elizabeth

2018-01-01

There are powerful demographic, political, and environmental trends shaping women’s health. Increases in life expectancy, literacy, and empowerment are fueling expansions in education and advocacy. Research and development focuses on women’s health and fertility across an expanded age spectrum. There is also a cultural emphasis on antiaging and aesthetics. In parallel, the digital revolution is changing how health care is accessed by and delivered to women. A women’s journey through menopause is at the crossroads of these transformations. Medical and social platforms encourage women to embrace menopause as a pivotal life stage. Yet, many women are reticent to discuss “the transition” due to embarrassment about its symptoms, lack of awareness of its physical manifestations, or fear of aging. We introduce a patient-centric framework to support patient-provider engagement on menopause: prevention, anxiety, urogenital symptoms, vasomotor symptoms, and education. Although not comprehensive, PAUSE represents an acronym and reminder to focus a portion of the medical interaction on menopause. PMID:29467590

Imaging of breast cancer with mid- and long-wave infrared camera.

PubMed

Joro, R; Lääperi, A-L; Dastidar, P; Soimakallio, S; Kuukasjärvi, T; Toivonen, T; Saaristo, R; Järvenpää, R

2008-01-01

In this novel study the breasts of 15 women with palpable breast cancer were preoperatively imaged with three technically different infrared (IR) cameras - micro bolometer (MB), quantum well (QWIP) and photo voltaic (PV) - to compare their ability to differentiate breast cancer from normal tissue. The IR images were processed, the data for frequency analysis were collected from dynamic IR images by pixel-based analysis and from each image selectively windowed regional analysis was carried out, based on angiogenesis and nitric oxide production of cancer tissue causing vasomotor and cardiogenic frequency differences compared to normal tissue. Our results show that the GaAs QWIP camera and the InSb PV camera demonstrate the frequency difference between normal and cancerous breast tissue; the PV camera more clearly. With selected image processing operations more detailed frequency analyses could be applied to the suspicious area. The MB camera was not suitable for tissue differentiation, as the difference between noise and effective signal was unsatisfactory.

Actual status of veralipride use

PubMed Central

Carranza-Lira, Sebastián

2010-01-01

During the climacteric period, several symptoms exist that motivate women to seek medical advice; one of the most common is the hot flush, which presents in 75%–85% of these during a variable time span. For the treatment of hot flush, several non-hormonal treatments exist; among them, veralipride has shown to be a useful treatment of vasomotor symptoms during the climacteric period. In recent times, several medical societies have discredited its use. The purpose of this review, therefore, is to define a measured position in relation to the use of this drug. On completion of this review, it was possible to conclude that this drug has an antidopaminergic mechanism of action. The recommended schedule is: 100 mg/day for 20 days, with 10 days drug free. Since the risk of undesirable secondary effects such as galactorrhea, mastodynia, and extrapyramidal can increase with use, no more than 3 treatment cycles are recommended. This drug has a residual effect that can allow drug-free intervals, which permit a longer time between schedules. PMID:20852674

Management of menopause in women with breast cancer.

PubMed

Vincent, A J

2015-10-01

Increasing breast cancer incidence and decreasing mortality have highlighted the importance of survivorship issues related to breast cancer. A consideration of the issues related to menopause is therefore of great importance to both women and clinicians. Menopause/menopausal symptoms, with significant negative effects on quality of life and potential long-term health impacts, may in women with breast cancer be associated with: (1) natural menopause occurring concurrently with a breast cancer diagnosis; (2) recurrence of menopausal symptoms following cessation of hormone replacement therapy; (3) treatment-induced menopause (chemotherapy, ovarian ablation/suppression) and adjuvant endocrine therapy. A variety of non-hormonal pharmacological and non-pharmacological therapies have been investigated as therapeutic options for menopausal symptoms with mixed results, and ongoing research is required. This review presents a summary of the causes, common problematic symptoms of menopause (vasomotor, genitourinary and sexual dysfunction), and longer-term consequences (cardiovascular disease and osteoporosis) related to menopause. It proposes an evidenced-based multidisciplinary approach to the management of menopause/menopausal symptoms in women with breast cancer.

Migraine Management During Menstruation and Menopause.

PubMed

MacGregor, E Anne

2015-08-01

Migraine is most prevalent in women during their reproductive years. An understanding of the effects of menstruation and menopause on migraine can enable neurologists to provide targeted and appropriate medical and hormonal strategies, enabling their patients to achieve better control of migraine and reduced disability. This article reviews the effects of hormonal events on migraine and summarizes the evidence-based options available for management. Estrogen "withdrawal" during the late luteal phase of the natural menstrual cycle and the hormone-free interval of combined hormonal contraceptives has long been implicated in the pathophysiology of menstrual migraine. However, more recent research suggests that other independent mechanisms may be relevant. Prostaglandin inhibitors used for management of dysmenorrhea are effective for associated menstrual migraine, suggesting a common pathophysiology. The interplay between serotonin and estrogen also deserves further research. Menstrual and perimenopausal migraine can be managed effectively using a variety of strategies, the choice of which depends on the efficacy of acute treatment, predictability and regularity of menstruation, use of contraception, and presence of menstrual disorders or perimenopausal vasomotor symptoms.

L-Cysteine and L-AP4 microinjections in the rat caudal ventrolateral medulla decrease arterial blood pressure.

PubMed

Takemoto, Yumi

2014-12-01

The thiol amino acid L-cysteine increases arterial blood pressure (ABP) when injected into the cerebrospinal fluid space in conscious rats, indicating a pressor response to centrally acting L-cysteine. A prior synaptic membrane binding assay suggests that L-cysteine has a strong affinity for the L-2-amino-4-phosphonobutyric acid (L-AP4) binding site. The central action of L-cysteine may be vial-AP4 sensitive receptors. The present study investigated cardiovascular responses to L-cysteine and L-ap4 microinjected into the autonomic area of the caudal ventrolateral medulla (CVLM) where inhibitory neurons regulate ABP via pre-sympathetic vasomotor neurons. Both the injection of L-cysteine and L-AP4 in the CVLM sites identified with L-glutamate produced the same depressor and bradycardic responses in urethane-anesthetized rats. Neither a prior antagonist microinjection of MK801 for the N-methyl-D-aspartate (NMDA) receptor nor CNQX for the non-NMDA receptor attenuated the responses to L-cysteine, but the combination of the two receptor blocking with an additional prior injection abolished the response. In contrast, either receptor blockade alone abolished the response to L-AP4, indicating distinct mechanisms between responses to L-cysteine and L-AP4 in the CVLM. The results indicate that the CVLM is a central active site for L-cysteine's cardiovascular response. Central L-cysteine's action could be independent of the L-AP4 sensitive receptors. Cardiovascular regulation may involve endogenous L-cysteine in the CVLM. Further multidisciplinary examinations are required to elaborate on L-cysteine's functional roles in the CVLM. Copyright © 2014 Elsevier B.V. All rights reserved.

Novel kinin B1 receptor agonists with improved pharmacological profiles.

PubMed

Côté, Jérôme; Savard, Martin; Bovenzi, Veronica; Bélanger, Simon; Morin, Josée; Neugebauer, Witold; Larouche, Annie; Dubuc, Céléna; Gobeil, Fernand

2009-04-01

There is some evidence to suggest that inducible kinin B1 receptors (B1R) may play beneficial and protecting roles in cardiovascular-related pathologies such as hypertension, diabetes, and ischemic organ diseases. Peptide B1R agonists bearing optimized pharmacological features (high potency, selectivity and stability toward proteolysis) hold promise as valuable therapeutic agents in the treatment of these diseases. In the present study, we used solid-phase methodology to synthesize a series of novel peptide analogues based on the sequence of Sar[dPhe(8)]desArg(9)-bradykinin, a relatively stable peptide agonist with moderate affinity for the human B1R. We evaluated the pharmacological properties of these peptides using (1) in vitro competitive binding experiments on recombinant human B1R and B2R (for index of selectivity determination) in transiently transfected human embryonic kidney 293 cells (HEK-293T cells), (2) ex vivo vasomotor assays on isolated human umbilical veins expressing endogenous human B1R, and (3) in vivo blood pressure tests using anesthetized lipopolysaccharide-immunostimulated rabbits. Key chemical modifications at the N-terminus, the positions 3 and 5 on Sar[dPhe(8)]desArg(9)-bradykinin led to potent analogues. For example, peptides 18 (SarLys[Hyp(3),Cha(5), dPhe(8)]desArg(9)-bradykinin) and 20 (SarLys[Hyp(3),Igl(5), dPhe(8)]desArg(9)-bradykinin) outperformed the parental molecule in terms of affinity, functional potency and duration of action in vitro and in vivo. These selective agonists should be valuable in future animal and human studies to investigate the potential benefits of B1R activation.

Postural tachycardia syndrome: time frequency mapping

NASA Technical Reports Server (NTRS)

Novak, V.; Novak, P.; Opfer-Gehrking, T. L.; Low, P. A.

1996-01-01

Orthostatic tachycardia is common but its specificity remains uncertain. Our preliminary work suggested that using autonomic function testing in conjunction with time-frequency mapping (TFM), it might be possible to characterize a subset of the postural tachycardia syndrome (POTS), that is due to a restricted autonomic neuropathy. We describe 20 patients (17 women and 3 men, aged 14-43 years) with florid POTS and 20 controls (14 women and 6 men, aged 20-41 years). Autonomic failure was quantified by its distribution (cardiovagal, adrenergic and sudomotor) and severity, a symptom profile was generated, and spectral indices, based on modified Wigner distribution during rest and head-up tilt (80 degrees) were evaluated. During tilt-up POTS patients differed from controls by an excessive heart rate (> 130 bpm) (P < 0.001), and higher diastolic pressure (P < 0.01). During rest, cardiovagal oscillations (at respiratory frequencies [RF]) and slow rhythms at nonrespiratory frequencies (NONRF) (from 0.01 to 0.07 Hz) in R-R intervals (RRI) (P < 0.01) were reduced. Both RF and NONRF rhythms in RRI were further blunted with tilt-up (P < 0.001). Slow adrenergic vasomotor rhythms in blood pressure (BP) (approximately 0.07 Hz) surged with tilt-up and returned to normal levels afterwards. The index of sympatho-vagal balance (NONRF-Systolic BP (SBP)/RF-RRI) was dramatically increased in POTS (P < 0.001). Distal postganglionic sudomotor failure was observed, and impairment of the BP responses to the Valsalva maneuver (phase II) suggested peripheral adrenergic dysfunction. Persistent orthostatic dizziness, tiredness, gastrointestinal symptoms and palpitations were common in POTS patients. It is possible to identify a subset of POTS patients who have a length-dependent autonomic neuropathy, affecting the peripheral adrenergic and cardiovagal fibers, with relative preservation of cardiac adrenergic fibers.

Brain-mediated dysregulation of the bone marrow activity in angiotensin II-induced hypertension.

PubMed

Jun, Joo Yun; Zubcevic, Jasenka; Qi, Yanfei; Afzal, Aqeela; Carvajal, Jessica Marulanda; Thinschmidt, Jeffrey S; Grant, Maria B; Mocco, J; Raizada, Mohan K

2012-11-01

Oxidative stress in the brain is implicated in increased sympathetic drive, inflammatory status, and vascular dysfunctions, associated with development and establishment of hypertension. However, little is known about the mechanism of this impaired brain-vascular communication. Here, we tested the hypothesis that increased oxidative stress in the brain cardioregulatory areas, such as the paraventricular nucleus of the hypothalamus, is driven by mitochondrial reactive oxygen species and leads to increased inflammatory cells (ICs) and decreased/dysfunctional endothelial progenitor cells (EPCs), thereby compromising vasculature repair and accelerating hypertension. Chronic angiotensin II infusion resulted in elevated blood pressure and sympathetic vasomotor drive, decreased spontaneous baroreflex gain, and increased microglia activation in the paraventricular nucleus. This was associated with 46% decrease in bone marrow (BM)-derived EPCs and 250% increase in BM ICs, resulting in 5-fold decrease of EPC/IC ratio in the BM. Treatment with mitochondrial-targeted antioxidant, a scavenger of mitochondrial O(2)(-·), intracerebroventricularly but not subcutaneously attenuated angiotensin II-induced hypertension, decreased activation of microglia in the paraventricular nucleus, and normalized EPCs/ICs. This functional communication between the brain and BM was confirmed by retrograde neuronal labeling from the BM with green fluorescent protein-tagged pseudorabies virus. Administration of green fluorescent protein-tagged pseudorabies virus into the BM resulted in predominant labeling of paraventricular nucleus neurons within 3 days, with some fluorescence in the nucleus tractus solitarius, the rostral ventrolateral medulla, and subfornical organ. Taken together, these data demonstrate that inhibition of mitochondrial reactive oxygen species attenuates angiotensin II-induced hypertension and corrects the imbalance in EPCs/ICs in the BM. They suggest that an imbalance in vascular reparative and ICs may perpetuate vascular pathophysiology in this model of hypertension.

Brain-Mediated Dysregulation of the Bone Marrow Activity in Angiotensin II-induced Hypertension

PubMed Central

Jun, Joo Yun; Zubcevic, Jasenka; Qi, Yanfei; Afzal, Aqeela; Carvajal, Jessica Marulanda; Thinschmidt, Jeffrey S; Grant, Maria B.; Mocco, J; Raizada, Mohan K

2012-01-01

Oxidative stress in the brain is implicated in increased sympathetic drive, inflammatory status and vascular dysfunctions, associated with development and establishment of hypertension. However, little is known about the mechanism of this impaired brain-vascular communication. Here, we tested the hypothesis that increased oxidative stress in the brain cardioregulatory areas, such as the paraventricular nucleus (PVN) of the hypothalamus, is driven by mitochondrial reactive oxygen species (ROS) and leads to increased inflammatory cells (ICs) and decreased/dysfunctional endothelial progenitor cells (EPCs), thereby compromising vasculature repair and accelerating hypertension. Chronic angiotensin II (Ang II) infusion resulted in elevated blood pressure and sympathetic vasomotor drive, decreased spontaneous baroreflex gain, and increased microglia activation in the PVN. This was associated with 46% decrease in BM EPCs and 250% increase in BM ICs, resulting in 5 fold decrease of EPCs/ICs ratio in the BM. Treatment with mitoTEMPO, a scavenger of mitochondrial O2−• intracerebroventricularly but not subcutaneously, attenuated Ang II-induced hypertension, decreased activation of microglia in the PVN, and normalized EPCs/ICs. This functional communication between the brain and BM was confirmed by retrograde neuronal labeling from the BM with GFP-tagged pseudorabies virus (PRV). Administration of GFP-PRV into the BM resulted in predominant labeling of PVN neurons within 3 days, with some fluorescence in the NTS, RVLM and SFO. Taken together, these data demonstrate that inhibition of mitochondrial ROS attenuates Ang II-induced hypertension and corrects the imbalance in EPCs/ICs in the BM. They suggest that an imbalance in vascular reparative and ICs may perpetuate vascular pathophysiology in this model of hypertension. PMID:23045460

Effect of spinal cord stimulation on myocardial perfusion reserve in patients with refractory angina pectoris.

PubMed

Saraste, Antti; Ukkonen, Heikki; Varis, Antti; Vasankari, Tuija; Tunturi, Satu; Taittonen, Markku; Rautakorpi, Pirkka; Luotolahti, Matti; Airaksinen, K E Juhani; Knuuti, Juhani

2015-04-01

Epidural spinal cord stimulation (SCS) provides symptom relief in refractory angina pectoris, but its mechanism of action remains incompletely understood. We studied effects of short-term SCS therapy on myocardial ischaemia tolerance, myocardial perfusion reserve (MPR), and endothelium-mediated vasodilatation induced by cold pressor test (CPT) in patients with refractory angina pectoris. We prospectively recruited 18 patients with refractory angina pectoris and studied them after implantation of SCS device at baseline before starting the therapy and after 3 weeks of continuous SCS therapy. Myocardial ischaemia was evaluated by dobutamine stress echocardiography. Global and regional myocardial blood flow (MBF) were measured using positron emission tomography and (15)O-water at rest, during adenosine stress, and in response to CPT. Systemic haemodynamics were comparable before and after 3 weeks of SCS at rest, during adenosine stress and during CPT. Appearance of angina pectoris induced by dobutamine stress was delayed after SCS therapy. Global MPR increased (P = 0.02) from 1.7 ± 0.6 at baseline to 2.0 ± 0.6 after 3-week SCS therapy. This was associated with a significant reduction in global MBF at rest and increase in MBF induced by adenosine in the ischaemic regions. Global MBF response to CPT was improved after SCS (0.27 ± 0.20 vs. 0.40 ± 0.15, P = 0.03). Short-term SCS therapy improved myocardial ischaemia tolerance, absolute MPR, and endothelium-mediated vasomotor function in refractory angina pectoris, indicating that this therapy can alleviate myocardial perfusion abnormalities in advanced CAD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Vascular smooth muscle dysfunction induced by monomethylarsonous acid (MMA III): a contributing factor to arsenic-associated cardiovascular diseases.

PubMed

Bae, Ok-Nam; Lim, Eun-Kyung; Lim, Kyung-Min; Noh, Ji-Yoon; Chung, Seung-Min; Lee, Moo-Yeol; Yun, Yeo-Pyo; Kwon, Seong-Chun; Lee, Jun-Ho; Nah, Seung-Yeol; Chung, Jin-Ho

2008-11-01

While arsenic in drinking water is known to cause various cardiovascular diseases in human, exact mechanism still remains elusive. Recently, trivalent-methylated arsenicals, the metabolites of inorganic arsenic, were shown to have higher cytotoxic potential than inorganic arsenic. To study the role of these metabolites in arsenic-induced cardiovascular diseases, we investigated the effect of monomethylarsonous acid (MMA III), a major trivalent-methylated arsenical, on vasomotor tone of blood vessels. In isolated rat thoracic aorta and small mesenteric arteries, MMA III irreversibly suppressed normal vasoconstriction induced by three distinct agonists of phenylephrine (PE), serotonin and endothelin-1. Inhibition of vasoconstriction was retained in aortic rings without endothelium, suggesting that MMA III directly impaired the contractile function of vascular smooth muscle. The effect of MMA III was mediated by inhibition of PE-induced Ca2+ increase as found in confocal microscopy and fluorimeter in-lined organ chamber technique. The attenuation of Ca2+ increase was from concomitant inhibition of release from intracellular store and extracellular Ca2+ influx via L-type Ca2+ channel, which was blocked by MMA III as shown in voltage-clamp assay in Xenopus oocytes. MMA III did not affect downstream process of Ca2+, as shown in permeabilized arterial strips. In in vivo rat model, MMA III attenuated PE-induced blood pressure increase indeed, supporting the clinical relevance of these in vitro findings. In conclusion, MMA III-induced smooth muscle dysfunction through disturbance of Ca2+ regulation, which results in impaired vasoconstriction and aberrant blood pressure change. This study will provide a new insight into the role of trivalent-methylated arsenicals in arsenic-associated cardiovascular diseases.

Flow in the left anterior descending coronary artery in patients with migraine headache.

PubMed

Aslan, Gamze; Sade, Leyla Elif; Yetis, Begum; Bozbas, Huseyin; Eroglu, Serpil; Pirat, Bahar; Can, Ufuk; Muderrisoglu, Haldun

2013-11-15

Migraine is a common neurovascular disorder characterized by attacks of severe headache, autonomic and neurologic symptoms. Migraine can affect many systems in the body, yet its effects on cardiovascular system are unclear. We hypothesized that migraine and coronary microvascular angina may be manifestations of a common systemic microvascular dysfunction and clinically associated. Forty patients with migraine and 35 healthy volunteers were included into the study. Using transthoracic Doppler echocardiography, coronary flow was visualized in the middle or distal part of the left anterior descending artery. Coronary diastolic peak flow velocities were measured with pulse wave Doppler at baseline and after dipyridamole infusion (0.56 mg/kg/4 min). Coronary flow reserve of <2 was considered normal. In addition, thorough 2-dimensional and Doppler echocardiographic examinations were also performed. Fifty-two women and 23 men were included. Coronary flow reserve was significantly lesser in the migraine group than in the control group (1.99 ± 0.3 vs 2.90 ± 0.5, p <0.05). In addition, mitral annular velocities were lower and the ratio of early mitral inflow velocity to early mitral annular velocity (E/E' lateral and E/E' septal) was higher in migraineurs than in the control group (p <0.05 for all), indicating diastolic function abnormalities in the migraine group. In conclusion, these findings suggest that there is an association between coronary microvascular dysfunction and migraine independently of the metabolic state of the patients. A common pathophysiologic pathway of impaired endothelial vasodilatation, vasomotor dysfunction, and increased systemic inflammatory factors may play a role in these 2 clinical conditions and could be the underlying cause of subclinical systolic and diastolic left ventricular dysfunction in migraineurs. Copyright © 2013 Elsevier Inc. All rights reserved.

The validity of the Menopause-specific Quality of Life questionnaire in women with type 2 diabetes.

PubMed

Hasan, S S; Ahmadi, K; Santigo, R; Ahmed, S I

2014-08-01

To examine the validity and reliability of the Menopause-specific Quality of Life (MENQOL) questionnaire in a sample of women with diabetes in Malaysia, with the secondary aim of determining whether MENQOL domain scores were associated with depression and diabetes. A total of 337 postmenopausal women (241 with diabetes, 96 controls) were evaluated. Construct validity was evaluated using principal components analysis (PCA) and comparing scale items against the mental component score of the Short Form-12 (SF-12 MCS), and against the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10). Consistency assessment was conducted using Cronbach's α. The internal consistencies for the physical (PHS), psychosocial (PS), sexual (VSS) and vasomotor domains were 0.86, 0.79, 0.79 and 0.70, and 0.90 for the full scale of MENQOL. PCA revealed a four-factorial model. Diabetes and non-diabetes subjects experienced their first period (13.25 vs. 13.10 years, p = 0.680) and achieved menopause around the same age (49.35 vs. 48.87 years, p = 0.426). We found significant variations in the MENQOL's PHS and PS domain scores that could be explained by SF-12 PCS (25%) and SF-12 MCS (20%) sub-scales. The validity of the MENQOL domains was demonstrated through significant associations with the equivalent SF-12 MCS and PCS subscales. The PS domain of the MENQOL also predicted the likelihood of symptoms of depression (1.42, 95% confidence interval 1.01-2.02). This study confirms the validity and internal consistency of the MENQOL questionnaire for measuring quality of life in postmenopausal women with diabetes, suggesting that the instrument can be used to screen people for menopausal symptoms.

Transcriptional upregulation of mitochondrial uncoupling protein 2 protects against oxidative stress-associated neurogenic hypertension.

PubMed

Chan, Samuel H H; Wu, Chiung-Ai; Wu, Kay L H; Ho, Ying-Hao; Chang, Alice Y W; Chan, Julie Y H

2009-10-23

Mitochondrial uncoupling proteins (UCPs) belong to a superfamily of mitochondrial anion transporters that uncouple ATP synthesis from oxidative phosphorylation and mitigates mitochondrial reactive oxygen species production. We assessed the hypothesis that UCP2 participates in central cardiovascular regulation by maintaining reactive oxygen species homeostasis in the rostral ventrolateral medulla (RVLM), where sympathetic premotor neurons that maintain vasomotor tone located. We also elucidated the molecular mechanisms that underlie transcriptional upregulation of UCP2 in response to oxidative stress in RVLM. In Sprague-Dawley rats, transcriptional upregulation of UCP2 in RVLM by rosiglitazone, an activator of its transcription factor peroxisome proliferator-activated receptor (PPAR)gamma, reduced mitochondrial hydrogen peroxide level in RVLM and systemic arterial pressure. Oxidative stress induced by microinjection of angiotensin II into RVLM augmented UCP2 mRNA or protein expression in RVLM, which was antagonized by comicroinjection of NADPH oxidase inhibitor (diphenyleneiodonium chloride), superoxide dismutase mimetic (tempol), or p38 mitogen-activated protein kinase inhibitor (SB203580) but not by extracellular signal-regulated kinase 1/2 inhibitor (U0126). Angiotensin II also induced phosphorylation of the PPARgamma coactivator, PPARgamma coactivator (PGC)-1alpha, and an increase in formation of PGC-1alpha/PPARgamma complexes in a p38 mitogen-activated protein kinase-dependent manner. Intracerebroventricular infusion of angiotensin II promoted an increase in mitochondrial hydrogen peroxide production in RVLM and chronic pressor response, which was potentiated by gene knockdown of UCP2 but blunted by rosiglitazone. These results suggest that transcriptional upregulation of mitochondrial UCP2 in response to an elevation in superoxide plays an active role in feedback regulation of reactive oxygen species production in RVLM and neurogenic hypertension associated with chronic oxidative stress.

Endothelin antagonism in portal hypertensive mice: implications for endothelin receptor-specific signaling in liver disease

PubMed Central

Feng, Hong-Qiang; Weymouth, Nate D.; Rockey, Don C.

2009-01-01

Endothelin-1 (ET-1), a potent vasoactive peptide, plays an important role in the pathogenesis of liver disease and portal hypertension. Two major endothelin receptors (ET-A and ET-B) mediate biological effects, largely on the basis of their known downstream signaling pathways. We hypothesized that the different receptors are likely to mediate divergent effects in portal hypertensive mice. Liver fibrosis and cirrhosis and portal hypertension were induced in 8-wk-old male BALB/c mice by gavage with carbon tetrachloride (CCl4). Portal pressure was recorded acutely during intravenous infusion of endothelin receptor antagonists in normal or portal hypertensive mice. In vivo microscopy was used to monitor sinusoidal dynamics. Additionally, the effect of chronic exposure to endothelin antagonists was assessed in mice during induction of fibrosis and cirrhosis with CCl4 for 8 wk. Intravenous infusion of ET-A receptor antagonists into normal and cirrhotic mice reduced portal pressure whereas ET-B receptor antagonism increased portal pressure. A mixed endothelin receptor antagonist also significantly reduced portal pressure. Additionally, the ET-A receptor antagonist caused sinusoidal dilation, whereas the ET-B receptor antagonist caused sinusoidal constriction. Chronic administration of each the endothelin receptor antagonists during the induction of fibrosis and portal hypertension led to reduced fibrosis, a significant reduction in portal pressure, and altered sinusoidal dynamics relative to controls. Acute effects of endothelin receptor antagonists are likely directly on the hepatic and sinusoidal vasculature, whereas chronic endothelin receptor antagonism appears to be more complicated, likely affecting fibrogenesis and the hepatic microcirculation. The data imply a relationship between hepatic fibrogenesis or fibrosis and vasomotor responses. PMID:19299580

Menopausal Quality of Life: A RCT of Yoga, Exercise and Omega-3 Supplements

PubMed Central

REED, Susan D; GUTHRIE, Katherine A; NEWTON, Katherine M; ANDERSON, Garnet L; BOOTH-LAFORCE, Cathryn; CAAN, Bette; CARPENTER, Janet S; COHEN, Lee S; DUNN, Andrea L; ENSRUD, Kristine E; FREEMAN, Ellen W; HUNT, Julie R; JOFFE, Hadine; LARSON, Joseph C; LEARMAN, Lee A; ROTHENBERG, Robin; SEGUIN, Rebecca A; SHERMAN, Karen J; STERNFELD, Barbara S; LACROIX, Andrea Z

2014-01-01

Objective Determine efficacy of three non-hormonal therapies for improving menopause-related quality of life (QOL) in women with vasomotor symptoms (VMS). Methods 12-week 3×2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, ages 40-62 years, were randomized to yoga (n=107), exercise (n=106), or usual activity (n=142), and also randomized to double-blind comparison of omega-3 (n=177) or placebo (n=178) capsules. Interventions: 1) weekly 90-minute yoga classes with daily at-home practice; 2) individualized facility-based aerobic exercise training 3 times/week; and 3) 0.615 gram omega-3 supplement, 3 times/day. Outcomes: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (VMS, psychosocial, physical and sexual) scores. Results Among 355 randomized women, average age 54.7 years, 338 (95%) completed 12-week assessments. Mean baseline VMS frequency was 7.6/day and mean baseline total MENQOL score was 3.8 (range 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% CI -0.6 to 0.0, p=0.02), and VMS (p=0.02) and sexuality (p=0.03) domain scores. For exercise and omega-3 compared to controls, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12-weeks (p=0.02). Conclusion All women become menopausal and many seek medical advice on ways to improve quality of life; little evidence-based information exists. We found, among healthy sedentary menopausal women, yoga appears to improve menopausal QOL - the clinical significance of our finding is uncertain due to modest effect. PMID:24215858

Myocardial Ischemia During Mental Stress: Role of Coronary Artery Disease Burden and Vasomotion

PubMed Central

Ramadan, Ronnie; Sheps, David; Esteves, Fabio; Maziar Zafari, A.; Douglas Bremner, J.; Vaccarino, Viola; Quyyumi, Arshed A.

2013-01-01

Background Mental stress–induced myocardial ischemia (MSIMI) is associated with adverse prognosis in patients with coronary artery disease (CAD), yet the mechanisms underlying this phenomenon remain unclear. We hypothesized that compared with exercise/pharmacological stress–induced myocardial ischemia (PSIMI) that is secondary to the atherosclerotic burden of CAD, MSIMI is primarily due to vasomotor changes. Methods and Results Patients with angiographically documented CAD underwent 99mTc‐sestamibi myocardial perfusion imaging at rest and following both mental and physical stress testing, performed on separate days. The severity and extent of CAD were quantified using the Gensini and Sullivan scores. Peripheral arterial tonometry (Itamar Inc) was used to assess the digital microvascular tone during mental stress as a ratio of pulse wave amplitude during speech compared with baseline. Measurements were made in a discovery sample (n=225) and verified in a replication sample (n=159). In the pooled (n=384) sample, CAD severity and extent scores were not significantly different between those with and without MSIMI, whereas they were greater in those with compared with those without PSIMI (P<0.04 for all). The peripheral arterial tonometry ratio was lower in those with compared with those without MSIMI (0.55±0.36 versus 0.76±0.52, P=0.009). In a multivariable analysis, the peripheral arterial tonometry ratio was the only independent predictor of MSIMI (P=0.009), whereas angiographic severity and extent of CAD independently predicted PSIMI. Conclusions The degree of digital microvascular constriction, and not the angiographic burden of CAD, is associated with MSIMI. Varying causes of MSIMI compared with PSIMI may require different therapeutic interventions that require further study. PMID:24145741

Sleep During Menopausal Transition: A 6-Year Follow-Up.

PubMed

Lampio, Laura; Polo-Kantola, Päivi; Himanen, Sari-Leena; Kurki, Samu; Huupponen, Eero; Engblom, Janne; Heinonen, Olli J; Polo, Olli; Saaresranta, Tarja

2017-07-01

Menopausal transition is associated with increased dissatisfaction with sleep, but the effects on sleep architecture are conflicting. This prospective 6-year follow-up study was designed to evaluate the changes in sleep stages and sleep continuity that occur in women during menopausal transition. Sixty women (mean age 46.0 years, SD 0.9) participated. All women were premenopausal at baseline, and at the 6-year follow-up, women were in different stages of menopausal transition. Polysomnography was used to study sleep architecture at baseline and follow-up. The effects of aging and menopause (assessed as change in serum follicle-stimulating hormone [S-FSH]) on sleep architecture were evaluated using linear regression models. After controlling for body mass index, vasomotor, and depressive symptoms, aging of 6 years resulted in shorter total sleep time (B -37.4, 95% confidence interval [CI] -71.5 to (-3.3)), lower sleep efficiency (B -6.5, 95%CI -12.7 to (-0.2)), as well as in increased transitions from slow-wave sleep (SWS) to wakefulness (B 1.0, 95%CI 0.1 to 1.9), wake after sleep onset (B 37.7, 95%CI 12.5 to 63.0), awakenings per hour (B 1.8, 95%CI 0.8 to 2.8), and arousal index (B 2.3, 95%CI 0.1 to 4.4). Higher S-FSH concentration in menopausal transition was associated with increased SWS (B 0.09, 95%CI 0.01 to 0.16) after controlling for confounding factors. A significant deterioration in sleep continuity occurs when women age from 46 to 52 years, but change from premenopausal to menopausal state restores some SWS. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Effect of estrogen replacement therapy on bone and cardiovascular outcomes in women with turner syndrome: a systematic review and meta-analysis.

PubMed

Cintron, Dahima; Rodriguez-Gutierrez, Rene; Serrano, Valentina; Latortue-Albino, Paula; Erwin, Patricia J; Murad, Mohammad Hassan

2017-02-01

Patients with Turner syndrome have adverse bone and cardiovascular outcomes from chronic estrogen deficiency. Hence, long-term estrogen replacement therapy is the cornerstone treatment. The estimates of its effect and optimal use, however, remain uncertain. We aimed to summarize the benefits and harms of estrogen replacement therapy on bone, cardiovascular, vasomotor and quality of life outcomes in patients with Turner syndrome. A comprehensive search of four databases was performed from inception through January 2016. Randomized clinical trials and observational cohort studies studying the effect of estrogen replacement therapy in patients with Turner syndrome under the age of 40 were included. Independently and in duplicate reviewers selected studies, extracted data and assessed risk of bias. Subgroup analyses were based on route of administration and type of estrogen formulation. Twenty-five studies at moderate to high risk of bias (12 randomized trials, 13 cohort studies) with 771 patients were included. Using random-effects models, estrogen replacement therapy showed an increase in bone mineral density [weighted mean change from baseline 0.09 g/cm2 (0.04-0.14)] that differed by type of estrogen but not route of administration. Oral estrogen replacement therapy showed a higher increase in high density lipoprotein cholesterol levels when compared to transdermal [weighted mean difference 9.33 mg/dl (4.82-13.85)] with no significant effect on other lipid fractions. The current evidence suggests possible benefit of estrogen replacement therapy on bone mineral density and high density lipoprotein cholesterol. Whether this improvement translates into changes in patient important outcomes (cardiovascular events or fractures) remains uncertain. Larger randomized clinical trials with direct comparisons on patient important outcomes are necessary.

Effects of Cooling During Exercise on Thermoregulatory Responses of Men With Paraplegia.

PubMed

Bongers, Coen C W G; Eijsvogels, Thijs M H; van Nes, Ilse J W; Hopman, Maria T E; Thijssen, Dick H J

2016-05-01

People with spinal cord injury (SCI) have an altered afferent input to the thermoregulatory center, resulting in a reduced efferent response (vasomotor control and sweating capacity) below the level of the lesion. Consequently, core body temperature rises more rapidly during exercise in individuals with SCI compared with people who are able-bodied. Cooling strategies may reduce the thermophysiological strain in SCI. The aim of this study was to examine the effects of a cooling vest on the core body temperature response of people with a thoracic SCI during submaximal exercise. Ten men (mean age=44 years, SD=11) with a thoracic lesion (T4-T5 or below) participated in this randomized crossover study. Participants performed two 45-minute exercise bouts at 50% maximal workload (ambient temperature 25°C), with participants randomized to a group wearing a cooling vest or a group wearing no vest (separate days). Core body temperature and skin temperature were continuously measured, and thermal sensation was assessed every 3 minutes. Exercise resulted in an increased core body temperature, skin temperature, and thermal sensation, whereas cooling did not affect core body temperature. The cooling vest effectively decreased skin temperature, increased the core-to-trunk skin temperature gradient, and tended to lower thermal sensation compared with the control condition. The lack of differences in core body temperature among conditions may be a result of the relative moderate ambient temperature in which the exercise was performed. Despite effectively lowering skin temperature and increasing the core-to-trunk skin temperature gradient, there was no impact of the cooling vest on the exercise-induced increase in core body temperature in men with low thoracic SCI. © 2016 American Physical Therapy Association.

Percutaneous radiofrequency ablation for osteoid osteoma under guidance of threedimensional fluoroscopy.

PubMed

Arıkan, Yavuz; Yavuz, Umut; Lapcin, Osman; Sökücü, Sami; Özkan, Bilge; Kabukçuoğlu, Yavuz

2016-12-01

To evaluate the outcome of percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy in 17 patients with osteoid osteoma. Records of 11 male and 6 female consecutive patients aged 4 to 28 (mean, 13.8) years who underwent radiofrequency ablation under guidance of 3-dimensional fluoroscopy for osteoid osteoma and were followed up for a mean of 15.8 (range, 12-28) months were reviewed. All patients had been treated with analgesics but failed to achieve lasting pain relief. Visual analogue score (VAS) for pain was assessed pre- and post-operatively. Absence of pain was considered recovery. The mean operating time was 55 (range, 20-95) minutes, and the mean length of hospital stay was 2.8 (range, 2-7) days. The mean amount of radiation was 390.2 (range, 330.5-423.6) mGy/cm. Relief of pain occurred within the first 24 hours in 11 patients and by the end of the first week in 3 patients. Pain persisted in 3 patients at one month; they underwent revision surgery and achieved complete recovery. The mean VAS for pain was 7.2 (range, 6-9) in 17 patients preoperatively and decreased to 0.64 (range, 0-2) in the 14 patients with pain relief and 0.66 (range, 0-1) in the 3 patients after revision surgery. Two patients had severe discharge from the wound secondary to fat necrosis, which resolved within a week with antibiotics and local dressings. No patient had cellulitis, vasomotor instability, neurovascular injury, fracture, or deep infection. Percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy is a viable treatment option for osteoid osteoma.

Germline variants in the CYP19A1 gene are related to specific adverse events in aromatase inhibitor users: a substudy of Dutch patients in the TEAM trial.

PubMed

Fontein, Duveken B Y; Houtsma, Daniel; Nortier, Johan W R; Baak-Pablo, Renee F; Kranenbarg, Elma Meershoek-Klein; van der Straaten, Tahar R J H M; Putter, Hein; Seynaeve, Caroline; Gelderblom, Hans; van de Velde, Cornelis J H; Guchelaar, Henk-Jan

2014-04-01

Musculoskeletal adverse events (MSAEs) and vasomotor symptoms (VMSs) are known side-effects of aromatase inhibitors, and may be related to genetic variations of the aromatase gene (CYP19A1). We investigated the relationship between these specific AEs and single nucleotide polymorphisms (SNPs) in the CYP19A1 gene in postmenopausal, hormone receptor-positive early breast cancer (BC) patients treated with adjuvant exemestane for 5 years. Dutch patients who were randomized to receive 5 years of exemestane in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial were included. A tagging-SNP approach was performed, covering 80 % of variations of the CYP19A1 gene with 30 SNPs. Logistic regression analyses were used to assess the risk of reporting VMSs or MSAEs in relation to genotypes within selected SNPs. Of 737 included patients, 281 patients reported at least one MSAE (n = 210) or VMS (n = 163). Homozygous AA genotype of rs934635 was associated with a significantly higher odds of MSAEs (multivariate odds ratio (OR) 4.66, p = 0.008) and VMSs (multivariate OR 2.78, p = 0.044). Regarding both rs1694189 and rs7176005, the homozygous variant genotypes (TT) were associated with a higher odds of VMSs, but not MSAEs (OR 1.758, p = 0.025 and OR 6.361, p = 0.021, respectively). Our exploratory analysis demonstrated that some CYP19A1 gene variations may be associated with MSAEs and/or VMSs. Specifically, patients with the homozygous variant rs934635 genotype reported more MSAEs and VMSs. Although further confirmatory studies are warranted, genomic profiling can help identify patients at an increased risk of reporting these specific AEs, potentiating further personalized BC treatment.

Positron-emitting myocardial blood flow tracers and clinical potential.

PubMed

Schindler, Thomas H

2015-01-01

Positron-emitting myocardial flow radiotracers such as (15)O-water, (13)N-ammonia and (82)Rubidium in conjunction with positron-emission-tomography (PET) are increasingly applied in clinical routine for coronary artery disease (CAD) detection, yielding high diagnostic accuracy, while providing valuable information on cardiovascular (CV) outcome. Owing to a cyclotron dependency of (15)O-water and (13)N-ammonia, their clinical use for PET myocardial perfusion imaging is limited to a few centers. This limitation could be overcome by the increasing use of (82)Rubidium as it can be eluted from a commercially available (82)Strontium generator and, thus, is independent of a nearby cyclotron. Another novel F-18-labeled myocardial flow radiotracer is flurpiridaz which has attracted increasing interest due to its excellent radiotracer characteristics for perfusion and flow imaging with PET. In particular, the relatively long half-life of 109 minutes of flurpiridaz may afford a general application of this radiotracer for PET perfusion imaging comparable to technetium-99m-labeled single-photon emission computed tomography (SPECT). The ability of PET in conjunction with several radiotracers to assess myocardial blood flow (MBF) in ml/g/min at rest and during vasomotor stress has contributed to unravel pathophysiological mechanisms underlying coronary artery disease (CAD), to improve the detection and characterization of CAD burden in multivessel disease, and to provide incremental prognostic information in individuals with subclinical and clinically-manifest CAD. The concurrent evaluation of myocardial perfusion and MBF may lead to a new era of a personalized, image-guided therapy approach that may offer potential to further improve clinical outcome in CV disease patients but needing validation in large-scale clinical trials. Copyright © 2015 Elsevier Inc. All rights reserved.

Molecular basis and function of voltage-gated K+ channels in pulmonary arterial smooth muscle cells.

PubMed

Yuan, X J; Wang, J; Juhaszova, M; Golovina, V A; Rubin, L J

1998-04-01

K(+)-channel activity-mediated alteration of the membrane potential and cytoplasmic free Ca2+ concentration ([Ca2+]cyt) is a pivotal mechanism in controlling pulmonary vasomotor tone. By using combined approaches of patch clamp, imaging fluorescent microscopy, and molecular biology, we examined the electrophysiological properties of K+ channels and the role of different K+ currents in regulating [Ca2+]cyt and explored the molecular identification of voltage-gated K+ (KV)- and Ca(2+)-activated K+ (KCa)-channel genes expressed in pulmonary arterial smooth muscle cells (PASMC). Two kinetically distinct KV currents [IK(V)], a rapidly inactivating (A-type) and a noninactivating delayed rectifier, as well as a slowly activated KCa current [IK(Ca)] were identified. IK(V) was reversibly inhibited by 4-aminopyridine (5 mM), whereas IK(Ca) was significantly inhibited by charybdotoxin (10-20 nM). K+ channels are composed of pore-forming alpha-subunits and auxiliary beta-subunits. Five KV-channel alpha-subunit genes from the Shaker subfamily (KV1.1, KV1.2, KV1.4, KV1.5, and KV1.6), a KV-channel alpha-subunit gene from the Shab subfamily (KV2.1), a KV-channel modulatory alpha-subunit (KV9.3), and a KCa-channel alpha-subunit gene (rSlo), as well as three KV-channel beta-subunit genes (KV beta 1.1, KV beta 2, and KV beta 3) are expressed in PASMC. The data suggest that 1) native K+ channels in PASMC are encoded by multiple genes; 2) the delayed rectifier IK(V) may be generated by the KV1.1, KV1.2, KV1.5, KV1.6, KV2.1, and/or KV2.1/KV9.3 channels; 3) the A-type IK(V) may be generated by the KV1.4 channel and/or the delayed rectifier KV channels (KV1 subfamily) associated with beta-subunits; and 4) the IK(Ca) may be generated by the rSlo gene product. The function of the KV channels plays an important role in the regulation of membrane potential and [Ca2+]cyt in PASMC.

Efficacy of Femarelle for the treatment of climacteric syndrome in postmenopausal women: An open label trial.

PubMed

Chen, Fang-Ping; Chang, Chee Jen; Chao, An-Shine; Huang, Hong-Yuan; Huang, Jian-Pei; Wu, Meng-Hsing; Tsai, Ching-Chou; Kung, Fu-Tsai; Chang, Ching-Wen; Tsai, Yung-Chieh

2016-06-01

To assess the effects of 2 months of treatment with Femarelle for climacteric syndrome in Taiwanese postmenopausal women. A multi-center, open-label trial of 260 postmenopausal women, age ≥ 45 years with vasomotor symptoms. Women were enrolled after obtaining a detailed medical history and a thorough physical examination. They then received Femarelle (640 mg/d) twice daily for 8 weeks. The primary outcome was the changes in the frequency and severity of hot flushes from baseline to 4 weeks (1 month) and 8 weeks (2 months). Changes of general climacteric syndrome were assessed using a modified climacteric scale designed by Greene. The frequency and severity of hot flushes were significantly improved with Femarelle use (p < 0.001). After 8 weeks of treatment, the percentage of women with various climacteric syndromes was reduced (from 100% to 20.9% for hot flushes, from 97.7% to 87.9% for psychological symptoms, from 93.8% to 78.8% for somatic symptoms, and from 87.8% to 74.9% for sexual symptoms). General climacteric syndrome scores also significantly decreased, from 20.8 ± 0.7 at the time of enrollment to 12.9 ± 0.7 after 8 weeks of Femarelle treatment (p < 0.0001). Participants experienced improvement of various climacteric symptoms and signs after 8 weeks of treatment (75.1% for hot flushes, 68.7% for psychological symptoms, 70.6% for somatic symptoms, and 69.0% for sexual problems respectively). After 4 weeks and 8 weeks of treatment with Femarelle, patients showed statistically significant improvement in climacteric symptoms (p < 0.0001). Three women (1.2%) withdrew from the study after 4 weeks of treatment due to adverse effects. Femarelle significantly improved climacteric symptoms in Taiwanese postmenopausal women. However, further evaluation is needed regarding the safety of long-term consumption. Copyright © 2016. Published by Elsevier B.V.

Temperature-dependent regulation of blood distribution in snakes.

PubMed

Amiel, Joshua J; Chua, Beverly; Wassersug, Richard J; Jones, David R

2011-05-01

Regional control of blood flow is often suggested as a mechanism for fine thermoregulatory adjustments in snakes. However, the flow of blood to different body regions at various temperatures has never been visualized to confirm this mechanism. We used (99m)technetium-labelled macroaggregated albumin ((99m)Tc-MAA), a radioactive tracer, to follow the flow of blood through the bodies of garter snakes (Thamnophis sirtalis) near their thermal maxima and minima. We injected snakes with(99m)Tc-MAA at cold (6-8°C) and hot (27-32°C) temperatures and imaged them using a gamma scanner. At cold ambient temperatures, snakes significantly reduced the blood flow to their tails and significantly increased the blood flow to their heads. Conversely, at hot ambient temperatures, snakes significantly increased the blood flow to their tails and significantly reduced the blood flow to their heads. This confirms that snakes are able to use differential blood distribution to regulate temperature. Our images confirm that snakes use regional control of blood flow as a means of thermoregulation and that vasomotor control of vascular beds is likely to be the mechanism of control.

Description of an Audio-Based Paced Respiration Intervention for Vasomotor Symptoms

PubMed Central

Burns, Debra S.; Drews, Michael R.; Carpenter, Janet S.

2013-01-01

Millions of women experience menopause-related hot flashes or flushes that may have a negative effect on their quality of life. Hormone therapy is an effective treatment, however, it may be contraindicated or unacceptable for some women based on previous health complications or an undesirable risk–benefit ratio. Side effects and the unacceptability of hormone therapy have created a need for behavioral interventions to reduce hot flashes. A variety of complex, multimodal behavioral, relaxation-based interventions have been studied with women (n = 88) and showed generally favorable results. However, currently extensive resource commitments reduce the translation of these interventions into standard care. Slow, deep breathing is a common component in most interventions and may be the active ingredient leading to reduced hot flashes. This article describes the content of an audio-based program designed to teach paced breathing to reduce hot flashes. Intervention content was based on skills training theory and music entrainment. The audio intervention provides an efficient way to deliver a breathing intervention that may be beneficial to other clinical populations. PMID:23914283

Cytological Aspects on the Effects of a Nasal Spray Consisting of Standardized Extract of Citrus Lemon and Essential Oils in Allergic Rhinopathy

PubMed Central

Ferrara, Lydia; Naviglio, Daniele; Armone Caruso, Arturo

2012-01-01

In this paper, a new formulation of nasal spray was set up based on the extract of lemon pulp, obtained by using a new solid-liquid technology of extraction, added to pure Aloe juice, soluble propoli, and essential oils of Ravensara and Niaouly. It was tested in a clinical study in which 100 subjects were recruited for a period of one month. Nasal scraping was used for collecting samples and after the application of the May-Grünwald Giemsa standard technique, glass slides were analysed by using optical microscope with a 1000x oil immersion. A control group constituted of ten people was recruited as control and this group was administered with physiological solution (saline solution). The comparison of results obtained before and after the application of nasal spray showed a total reduction of eosinophils granulocytes and mast cells; clinical data were confirmed by improvement of clinical pictures of patients. The lemon-based nasal spray was a good alternative to conventional medicine for the treatment of perennial and seasonal allergic and vasomotor rhinopathy. PMID:23304560

Temporal Alterations in Vascular Angiotensin Receptors and Vasomotor Response in Offspring of Protein-restricted Rat Dams

PubMed Central

SATHISHKUMAR, Kunju; BALAKRISHNAN, Meena; CHINNATHAMBI, Vijayakumar; GAO, Haijun; YALLAMPALLI, Chandra

2012-01-01

Objective Examine temporal alterations in vascular angiotensin II (ANG II) receptors (AT1R and AT2R) and determine vascular response to ANG II in growth-restricted offspring. Study design Offspring of pregnant rats fed low-protein (6%) and control (20%) diet were compared. Results Prenatal protein restriction reprogrammed AT1aR mRNA expression in males’ mesenteric arteries to cause 1.7- and 2.3-fold increases at 3 and 6 months of age associated with arterial pressure increases of 10 and 33 mmHg, respectively; however, in females, increased AT1aR expression (2-fold) and arterial pressure (15 mmHg) occurred only at 6 months. Prenatal protein restriction did not affect AT2R expression. Losartan abolished hypertension, suggesting that AT1aR plays a primary role in arterial pressure elevation. Vasoconstriction to ANG II was exaggerated in all protein-restricted offspring, with greater potency and efficacy in males. Conclusion Prenatal protein restriction increased vascular AT1R expression and vasoconstriction to ANG II, possibly contributing to programmed hypertension. PMID:22537420

Regulation of coronary blood flow. Effect of coronary artery stenosis.

PubMed

Duncker, D J; Merkus, D

2004-12-01

The consistently high level of myocardial oxygen extraction requires tight control of coronary blood flow, because an increase in myocardial oxygen demand, as occurs during exercise, cannot be obtained by a further increase in oxygen extraction. Consequently, adequate control of coronary vascular resistance is critical. Coronary resistance vessel tone is the result of a myriad of vasodilator and vasoconstrictor influences, which are exerted by the myocardium, endothelium and neurohumoral status. Unraveling of the integrative mechanisms controlling metabolic vasodilation has been difficult, more than likely due to the redundancy design of vasomotor control. In contrast to the traditional view that myocardial ischemia produced by a coronary artery stenosis causes maximal microvascular dilation, more recent studies have shown that the coronary microvessels retain some degree of vasodilator reserve during ischemia and remain responsive to vasoconstrictor stimuli. These observations raise the question of whether pharmacologic vasodilators acting at the microvascular level might be therapeutically useful. The critical property of effective vasodilator therapy requires selective dilation of small arteries, while avoiding coronary steal by not interfering with metabolic vasoregulation at the level of the arterioles.

Myocardial perfusion imaging study of CO(2)-induced panic attack.

PubMed

Soares-Filho, Gastão L F; Machado, Sergio; Arias-Carrión, Oscar; Santulli, Gaetano; Mesquita, Claudio T; Cosci, Fiammetta; Silva, Adriana C; Nardi, Antonio E

2014-01-15

Chest pain is often seen alongside with panic attacks. Moreover, panic disorder has been suggested as a risk factor for cardiovascular disease and even a trigger for acute coronary syndrome. Patients with coronary artery disease may have myocardial ischemia in response to mental stress, in which panic attack is a strong component, by an increase in coronary vasomotor tone or sympathetic hyperactivity setting off an increase in myocardial oxygen consumption. Indeed, coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. These findings correlating panic disorder with coronary artery disease lead us to raise questions about the favorable prognosis of chest pain in panic attack. To investigate whether myocardial ischemia is the genesis of chest pain in panic attacks, we developed a myocardial perfusion study through research by myocardial scintigraphy in patients with panic attacks induced in the laboratory by inhalation of 35% carbon dioxide. In conclusion, from the data obtained, some hypotheses are discussed from the viewpoint of endothelial dysfunction and microvascular disease present in mental stress response. Copyright © 2014 Elsevier Inc. All rights reserved.

Influences of natural menopause on health complaints: a prospective study of healthy Norwegian women.

PubMed

Holte, A

1992-01-01

As a continuation of a cross-sectional study in 1981 involving a representative sample of 1886 women between 45 and 55 years of age, 200 pre-menopausal subjects were selected randomly to take part in a follow-up study. Eighty-seven single measures covering 26 areas of health complaints which have been associated with the menopause in medical textbooks were investigated. A tentative method for relating health complaints at several time points to menopausal status is proposed. A significant number of women reported an increase in vasomotor complaints, vaginal dryness, heart palpitations and social dysfunction following the menopause, although many reported no change or even a reduction in these complaints. On the other hand, a decrease in headache and breast tenderness was noted. No significant differences were observed between the numbers of women reporting an increase or a decrease respectively on any of the other 69 measures (20 complaints), which included anxiety, depression and irritability. Further analyses indicated that the increase in social dysfunction was caused by hot flushes and sweating. This paper raises a number of issues regarding the methodology of longitudinal studies.

Disconnect Between Adipose Tissue Inflammation and Cardiometabolic Dysfunction in Ossabaw Pigs

PubMed Central

Vieira-Potter, Victoria J.; Lee, Sewon; Bayless, David S.; Scroggins, Rebecca J.; Welly, Rebecca J.; Fleming, Nicholas J.; Smith, Thomas N.; Meers, Grace M.; Hill, Michael A.; Rector, R. Scott; Padilla, Jaume

2015-01-01

Objective The Ossabaw pig is emerging as an attractive model of human cardiometabolic disease due to its size and susceptibility to atherosclerosis, among other characteristics. Here we investigated the relationship between adipose tissue inflammation and metabolic dysfunction in this model. Methods Young female Ossabaw pigs were fed a western-style high-fat diet (HFD) (n=4) or control low-fat diet (LFD) (n=4) for a period of 9 months and compared for cardiometabolic outcomes and adipose tissue inflammation. Results The HFD-fed “OBESE” pigs were 2.5 times heavier (p<0.001) than LFD-fed “LEAN” pigs and developed severe obesity. HFD-feeding caused pronounced dyslipidemia, hypertension, insulin resistance (systemic and adipose) as well as induction of inflammatory genes, impairments in vasomotor reactivity to insulin and atherosclerosis in the coronary arteries. Remarkably, visceral, subcutaneous and perivascular adipose tissue inflammation (via FACS analysis and RT-PCR) was not increased in OBESE pigs, nor were circulating inflammatory cytokines. Conclusions These findings reveal a disconnect between adipose tissue inflammation and cardiometabolic dysfunction induced by western diet feeding in the Ossabaw pig model. PMID:26524201

Treating schizophrenia during menopause.

PubMed

Brzezinski, Amnon; Brzezinski-Sinai, Noa A; Seeman, Mary V

2017-05-01

The aim of this review is to examine three questions: What are the risks and benefits of treating women with schizophrenia with hormone therapy (HT) at menopause? Should the antipsychotic regimen be changed at menopause? Do early- and late-onset women with schizophrenia respond differently to HT at menopause? MEDLINE databases for the years 1990 to 2016 were searched using the following interactive terms: schizophrenia, gender, menopause, estrogen, and hormones. The selected articles (62 out of 800 abstracts) were chosen on the basis of their applicability to the objectives of this targeted narrative review. HT during the perimenopause in women with schizophrenia ameliorates psychotic and cognitive symptoms, and may also help affective symptoms. Vasomotor, genitourinary, and sleep symptoms are also reduced. Depending on the woman's age and personal risk factors and antipsychotic side effects, the risk of breast cancer and cardiovascular disease may be increased. Antipsychotic types and doses may need to be adjusted at menopause, as may be the mode of administration. Both HT and changes in antipsychotic management should be considered for women with schizophrenia at menopause. The question about differences in response between early- and late-onset women cannot yet be answered.

Aromatherapy massage affects menopausal symptoms in korean climacteric women: a pilot-controlled clinical trial.

PubMed

Hur, Myung-Haeng; Yang, Yun Seok; Lee, Myeong Soo

2008-09-01

This study investigated the effects of aromatherapy massage on menopausal symptoms in Korean climacteric women. Kupperman's menopausal index was used to compare an experimental group of 25 climacteric women with a wait-listed control group of 27 climacteric women. Aromatherapy was applied topically to subjects in the experimental group in the form of massage on the abdomen, back and arms using lavender, rose geranium, rose and jasmine in almond and primrose oils once a week for 8 weeks (eight times in total). The experimental group reported a significantly lower total menopausal index than wait-listed controls (P < 0.05). There were also significant intergroup differences in subcategories such as vasomotor, melancholia, arthralgia and myalgia (all P < 0.05). These findings suggest that aromatherapy massage may be an effective treatment of menopausal symptoms such as hot flushes, depression and pain in climacteric women. However, it could not be verified whether the positive effects were from the aromatherapy, the massage or both. Further rigorous studies should be done with more objective measures.

Aromatherapy Massage Affects Menopausal Symptoms in Korean Climacteric Women: A Pilot-Controlled Clinical Trial

PubMed Central

Hur, Myung-Haeng; Yang, Yun Seok

2008-01-01

This study investigated the effects of aromatherapy massage on menopausal symptoms in Korean climacteric women. Kupperman's menopausal index was used to compare an experimental group of 25 climacteric women with a wait-listed control group of 27 climacteric women. Aromatherapy was applied topically to subjects in the experimental group in the form of massage on the abdomen, back and arms using lavender, rose geranium, rose and jasmine in almond and primrose oils once a week for 8 weeks (eight times in total). The experimental group reported a significantly lower total menopausal index than wait-listed controls (P < 0.05). There were also significant intergroup differences in subcategories such as vasomotor, melancholia, arthralgia and myalgia (all P < 0.05). These findings suggest that aromatherapy massage may be an effective treatment of menopausal symptoms such as hot flushes, depression and pain in climacteric women. However, it could not be verified whether the positive effects were from the aromatherapy, the massage or both. Further rigorous studies should be done with more objective measures. PMID:18830459

Carcinoid heart disease.

PubMed

Hassan, Saamir A; Banchs, Jose; Iliescu, Cezar; Dasari, Arvind; Lopez-Mattei, Juan; Yusuf, Syed Wamique

2017-10-01

Rare neuroendocrine tumours (NETs) that most commonly arise in the gastrointestinal tract can lead to carcinoid syndrome and carcinoid heart disease. Patients with carcinoid syndrome present with vasomotor changes, hypermotility of the gastrointestinal system, hypotension and bronchospasm. Medical therapy for carcinoid syndrome, typically with somatostatin analogues, can help control symptoms, inhibit tumour progression and prolong survival. Carcinoid heart disease occurs in more than 50% of these patients and is the initial presentation of carcinoid syndrome in up to 20% of patients. Carcinoid heart disease has characteristic findings of plaque-like deposits composed of smooth muscle cells, myofibroblasts, extracellular matrix and an overlying endothelial layer which can lead to valve dysfunction. Valvular dysfunction can lead to oedema, ascites and right-sided heart failure. Medical therapy of carcinoid heart disease is limited to symptom control and palliation. Valve surgery for carcinoid heart disease should be considered for symptomatic patients with controlled metastatic carcinoid syndrome. A multidisciplinary approach is needed to guide optimal management. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Temperature regulates limb length in homeotherms by directly modulating cartilage growth

PubMed Central

Serrat, Maria A.; King, Donna; Lovejoy, C. Owen

2008-01-01

Allen's Rule documents a century-old biological observation that strong positive correlations exist among latitude, ambient temperature, and limb length in mammals. Although genetic selection for thermoregulatory adaptation is frequently presumed to be the primary basis of this phenomenon, important but frequently overlooked research has shown that appendage outgrowth is also markedly influenced by environmental temperature. Alteration of limb blood flow via vasoconstriction/vasodilation is the current default hypothesis for this growth plasticity, but here we show that tissue perfusion does not fully account for differences in extremity elongation in mice. We show that peripheral tissue temperature closely reflects housing temperature in vivo, and we demonstrate that chondrocyte proliferation and extracellular matrix volume strongly correlate with tissue temperature in metatarsals cultured without vasculature in vitro. Taken together, these data suggest that vasomotor changes likely modulate extremity growth indirectly, via their effects on appendage temperature, rather than vascular nutrient delivery. When combined with classic evolutionary theory, especially genetic assimilation, these results provide a potentially comprehensive explanation of Allen's Rule, and may substantially impact our understanding of phenotypic variation in living and extinct mammals, including humans. PMID:19047632

A clip-free eyeglasses-based wearable monitoring device for measuring photoplethysmograhic signals.

PubMed

Zheng, Yali; Leung, Billy; Sy, Stanley; Zhang, Yuanting; Poon, Carmen C Y

2012-01-01

An eyeglasses-based device has been developed in this work to acquire photoplethysmogram (PPG) from the nose bridge. This device is aimed to provide wearable physiological monitoring without uncomfortable clips frequently used in PPG measurement from finger and ear. Switching control is applied on the LED and photo detector for power saving. An experiment involving postural change and treadmill jogging among 10 healthy young subjects was carried out to evaluate the performance of the device. Electrocardiogram (ECG) and PPG from finger, ear and nose were simultaneously recorded, from which heart rate (HR) and pulse transit time (PTT) were calculated. The results show that PPG measured from nose and ear are more resistant to motion than signal from finger during exercise. In addition, the difference between PTT measured from ear and nose indicates that local vasomotor activities may exist on ear and/or nose channel, and suggests that PPG from different sites should be used for cuff-less PTT-based BP estimation. We conclude that this wearable device has great potential to be used in the healthcare management in the future.

Cardiovascular dysfunction following spinal cord injury

PubMed Central

Partida, Elizabeth; Mironets, Eugene; Hou, Shaoping; Tom, Veronica J.

2016-01-01

Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury (SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia (AD). AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative – once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance. PMID:27073353

Heat regulation: homeostasis of central temperature in man.

PubMed

Benzinger, T H

1969-10-01

Focus is on the concept of the quantitative thermostat or setpoint as it evolved experimentally, not theoretically, from measurements of central temperature at the tympanic membrane and from measurements of physiological responses by human gradient layer calorimetry and continuous analysis of oxygen consumption. Heat-flow responses as they relate to stimuli by which they are evoked -- peripheral or central temperatures at thermoreceptive sites -- and discussed, and individual systems of reflex action are described. These systems are then correlated with what is known of their tangible components -- sensory receptors, effector organs, nervous centers, and afferent or efferent nervous pathways -- classically derived from anatomical studies, lesion experiments, recording of action currents, or electrical or thermal stimulation of pertinent structures. Such as correlation is a crucial test, and when the results are consistent, they provide independent, mutual confirmation via the 2 approaches. Doubts are then removed that lesions or interferences, which are unavoidable with most neurophysiological methods, may have produced artifacts. Conversely, calorimetry allows one to observe and analyze thermoregulation in process in a human subject without disturbing normal structures or functions other than by the stresses to which the body is made to respond. Prior to a description of experimental findings, the essential methods are reviewed. With the methods of gradient layer calorimetry, tympanic (eardrum) thermonetry, and indirect calorimetry, thermoregulatory responses -- by chemical overproduction of metabolic heat -- were observed in transient states as a result of a stimulus of cold impinging on peripheral neurons or warm-inhibition removed from central structures. With tympanic thermometry permitting for the 1st time om humans the continuous recording of central thermal stimulation, and with gradient calorimetry permitting the continuous recording (with insignificant inertial distortion) of the sweating responses in precisely controlled environments of a large variety and under conditions where complete evaporation of sweat is ensured by strong but smooth air convection, a new study of physical thermoregulation was initiated in 1958. The experimental results did not support the expection that sweating would follow the average temperature of the skin in the classical tradition, with skin warm-receptors as the hypothetical origin of exciting warm-impulses and cenral temperature as a participant prescribing the action of the "thermoregulator" in some as yet undetermined, additive, manner. Vasomotor mechanisms to human thermoregulation can be assessed in quantitative manner only by whole-body calorimetry. Mechanisms of thermal homeostasis also considered include hormonal regulation, transmitter substances, conscious sensation of warmth and coordinations of behavioral and autonomic mechanisms, setpoint and its variations, and fever.

Advice on lifestyle changes (diet, red wine and physical activity) does not affect internal carotid and middle cerebral artery blood flow velocity in patients with carotid arteriosclerosis in a randomized controlled trial.

PubMed

Droste, Dirk W; Iliescu, Catalina; Vaillant, Michel; Gantenbein, Manon; De Bremaeker, Nancy; Lieunard, Charlotte; Velez, Telma; Meyer, Michèle; Guth, Tessy; Kuemmerle, Andrea; Chioti, Anna

2014-01-01

A Mediterranean diet, with and without small daily amounts of red wine, and physical activity reduce the risk of cerebrovascular disease and improve cognition. An increase in cerebral blood flow may be the underlying mechanism. Under normal conditions, cerebral blood flow velocity changes in the internal carotid arteries and in large basal cerebral arteries correlate closely with cerebral blood flow changes, as the diameter of these vessels hardly changes and only the smaller vessels downstream change their diameter. A prospective randomized controlled trial was performed in 108 patients with carotid atherosclerosis (mean age 64 years, 67% men, 66% on statin therapy). Half of them were advised to follow a polyphenol-rich modified Mediterranean diet including 1-2 tomatoes, 3-5 walnuts and a bar of dark chocolate (25 g) a day and to perform moderate physical exercise for 30 min/day (lifestyle changes). Within these two groups, half of the patients were randomized either to avoid any alcohol or to drink 100 ml of red wine (women) or 200 ml of red wine (men) daily. Bilateral middle cerebral and internal carotid blood flow velocity (peak systolic, peak end-diastolic and mean) was measured at baseline and after 4 and 20 weeks using colour-coded duplex ultrasound. Insonation depth and insonation angle were used to identically place the sample volume during follow-up investigations. A general linear model with Tukey-Kramer adjustment for multiple comparisons was used to assess the primary end points. For the analysis we used the mean values of the right and left artery. Neither lifestyle changes nor red wine had an effect on peak systolic, peak end-diastolic or mean cerebral blood flow velocity. Advice on lifestyle changes, including a modified polyphenol-rich Mediterranean diet, a glass of red wine daily and physical exercise, did not affect middle cerebral and internal carotid blood flow velocity in our patient group with carotid atherosclerosis. An increase in cerebral blood flow is thus unlikely to be the cause of the reduced risk of cerebrovascular disease and improved cognitive functioning described in the literature. One possible explanation for the fact that blood flow velocity was not affected by red wine, diet and physical activity advice is that two thirds of our patients were already on statin therapy. Statins increase cerebral blood flow and vasomotor reactivity via nitric oxide. © 2014 S. Karger AG, Basel.

Bone marrow blood vessel ossification and "microvascular dead space" in rat and human long bone.

PubMed

Prisby, Rhonda D

2014-07-01

Severe calcification of the bone microvascular network was observed in rats, whereby the bone marrow blood vessels appeared ossified. This study sought to characterize the magnitude of ossification in relation to patent blood vessels and adipocyte content in femoral diaphyses. Additionally, this study confirmed the presence of ossified vessels in patients with arteriosclerotic vascular disease and peripheral vascular disease and cellulitis. Young (4-6 month; n=8) and old (22-24 month; n=8) male Fischer-344 rats were perfused with barium sulfate to visualize patent bone marrow blood vessels. Femoral shafts were processed for bone histomorphometry to quantify ossified (Goldner's Trichrome) and calcified (Alizarin Red) vessels. Adipocyte content was also determined. Additional femora (n=5/age group) were scanned via μCT to quantify microvascular ossification. Bone marrow blood vessels from the rats and the human patients were also isolated and examined via microscopy. Ossified vessels (rats and humans) had osteocyte lacunae on the vessel surfaces and "normal" vessels were transitioning into bone. The volume of ossified vessels was 4800% higher (p<0.05) in the old vs. young rats. Calcified and ossified vessel volumes per tissue volume and calcified vessel volume per patent vessel volume were augmented (p<0.05) 262%, 375% and 263%, respectively, in the old vs. young rats. Ossified and patent vessel number was higher (171%) and lower (40%), respectively, in the old vs. young rats. Finally, adipocyte volume per patent vessel volume was higher (86%) with age. This study is the first to report ossification of bone marrow blood vessels in rats and humans. Ossification presumably results in "microvascular dead space" in regard to loss of patency and vasomotor function as opposed to necrosis. Progression of bone microvascular ossification may provide the common link associated with age-related changes in bone and bone marrow. The clinical implications may be evident in the difficulties treating bone disease in the elderly. Copyright © 2014 Elsevier Inc. All rights reserved.

Bone Marrow Blood Vessel Ossification and “Microvascular Dead Space” in Rat and Human Long Bone

PubMed Central

Prisby, Rhonda D.

2014-01-01

Severe calcification of the bone microvascular network was observed in rats, whereby the bone marrow blood vessels appeared ossified. This study sought to characterize the magnitude of ossification in relation to patent blood vessels and adipocyte content in femoral diaphyses. Additionally, this study confirmed the presence of ossified vessels in patients with arteriosclerotic vascular disease and peripheral vascular disease and cellulitis. Young (4–6 mon; n=8) and old (22–24 mon; n=8) male Fischer-344 rats were perfused with barium sulfate to visualize patent bone marrow blood vessels. Femoral shafts were processed for bone histomorphometry to quantify ossified (Goldner’s Trichrome) and calcified (Alizarin Red) vessels. Adipocyte content was also determined. Additional femora (n=5/age group) were scanned via µCT to quantify microvascular ossification. Bone marrow blood vessels from rats and the human patients were also isolated and examined via microscopy. Ossified vessels (rats and humans) had osteocyte lacunae on the vessel surfaces and “normal” vessels were transitioning into bone. The volume of ossified vessels was 4800% higher (p <0.05) in old vs. young rats. Calcified and ossified vessel volumes per tissue volume and calcified vessel volume per patent vessel volume were augmented (p <0.05) 262%, 375% and 263%, respectively, in old vs. young rats. Ossified and patent vessel number was higher (171%) and lower (40%), respectively, in old vs. young rats. Finally, adipocyte volume per patent vessel volume was higher (86%) with age. This study is the first to report ossification of bone marrow blood vessels in rats and humans. Ossification presumably results in “microvascular dead space” in regards to loss of patency and vasomotor function as opposed to necrosis. The progression of bone microvascular ossification may provide the common link associated with age-related changes in bone and bone marrow. The clinical implications may be evident in the difficulties treating bone disease in the elderly. PMID:24680721

Inactivation of Nitric Oxide Synthesis Exacerbates the Development of Alzheimer Disease Pathology in APPPS1 Mice (Amyloid Precursor Protein/Presenilin-1).

PubMed

Cifuentes, Diana; Poittevin, Marine; Bonnin, Philippe; Ngkelo, Anta; Kubis, Nathalie; Merkulova-Rainon, Tatyana; Lévy, Bernard I

2017-07-31

The epidemiological link between hypertension and Alzheimer disease is established. We previously reported that hypertension aggravates the Alzheimer-like pathology in APPPS1 mice (amyloid precursor protein/presenilin-1, mouse model of Alzheimer disease) with angiotensin II-induced hypertension, in relation with hypertension and nitric oxide deficiency. To provide further insights into the role of nitric oxide in the hypertension-Alzheimer disease cross-talk, we studied the effects of nitric oxide blockade in APPPS1 mice using N (ω)-nitro-l-arginine methyl ester (l-NAME) alone or in combination with hydralazine, to normalize blood pressure. Compared with normotensive APPPS1 mice, those with l-NAME-induced hypertension had greater amyloid burden ( P <0.05), increased cortical amyloid angiopathy ( P <0.01), decreased regional microvascular density ( P <0.05), and deficient long-term spatial reference memory ( P <0.001). Blood pressure normalization with hydralazine did not protect APPPS1 mice from l-NAME-induced deterioration except for cortical amyloid angiopathy, linked to hypertension-induced arterial wall remodeling. By testing the cerebrovascular response to hypercapnic breathing, we evidenced early functional impairment of cerebral vasomotor activity in APPPS1 mice. Whereas in control wild-type normotensive mice, carbon dioxide breathing resulted in 15±1.3% increase in the mean blood flow velocity ( P <0.001), paradoxical mild decrease (1.5±0.4%) was recorded in normotensive APPPS1 mice ( P <0.001). Carbon dioxide-induced decrease in mean blood flow velocity was not significantly modified in l-NAME-treated hypertensive APPPS1 mice (2.5±1.2%) and partly reversed to mild vasodilation by hydralazine (3.2±1.5%, P <0.01). These results suggest that impaired nitric oxide bioavailability exacerbates the pathophysiology of Alzheimer disease, essentially impacting amyloid load and cognitive impairment, independently of l-NAME-induced hypertension. Only cerebral amyloid angiopathy seems to be dependent on hypertension. © 2017 American Heart Association, Inc.

Organization of the sympathetic innervation of the forelimb resistance vessels in the cat.

PubMed

Backman, S B; Stein, R D; Polosa, C

1999-02-01

Detailed information on the outflow pathway of sympathetic vasoconstrictor fibers to the upper extremity is lacking. We studied the organization of the sympathetic innervation of the forelimb resistance vessels and of the sinoatrial (SA) node in the decerebrated, artificially respirated cat. The distal portion of sectioned individual rami T1-8 and the sympathetic chain immediately caudal to T8 on the right side were electrically stimulated while the right forelimb perfusion pressure (forelimb perfused at constant flow) and heart rate were recorded. Increases in perfusion pressure were evoked by stimulation of T2-8 (maximal response T7: 55 +/- 2.3 mm Hg). Responses were still evoked by stimulation of the sympathetic chain immediately caudal to T8 (44 +/- 15 mm Hg). Increases in heart rate were evoked by the stimulation of more rostral rami (T1-5; maximal response T3: 55.2 +/- 8 bpm). These vasoconstrictor and cardioacceleratory responses were blocked by the cholinergic antagonists hexamethonium and scopolamine. Sectioning of the vertebral nerve and the T1 ramus abolished the vasoconstrictor response. Stimulation of the vertebral nerve and of the proximal portion of the sectioned T1 ramus increased perfusion pressure (69 +/- 9 and 34 +/- 14 mm Hg, respectively), which was unaffected by ganglionic cholinergic block. These data suggest that forelimb resistance vessel control is subserved by sympathetic preganglionic neurons located mainly in the middle to caudal thoracic spinal segments. Some of the postganglionic axons subserving vasomotor function course through the T1 ramus, in addition to the vertebral nerve. Forelimb vasculature is controlled by sympathetic preganglionic neurons located in middle to caudal thoracic spinal segments and by postganglionic axons carried in the T1 ramus and vertebral nerve. This helps to provide the anatomical substrate of interruption of sympathetic outflow to the upper extremity produced by major conduction anesthesia of the stellate ganglion or spinal cord.

Increased endothelin-1 vasoconstriction in mesenteric resistance arteries after superior mesenteric ischaemia-reperfusion

PubMed Central

Martínez-Revelles, S; Caracuel, L; Márquez-Martín, A; Dantas, AP; Oliver, E; D'Ocon, P; Vila, E

2012-01-01

BACKGROUND AND PURPOSE Endothelin-1 (ET-1) plays an important role in the maintenance of vascular tone. We aimed to evaluate the influence of superior mesenteric artery (SMA) ischaemia-reperfusion (I/R) on mesenteric resistance artery vasomotor function and the mechanism involved in the changes in vascular responses to ET-1. EXPERIMENTAL APPROACH SMA from male Sprague-Dawley rats was occluded (90 min) and following reperfusion (24 h), mesenteric resistance arteries were dissected. Vascular reactivity was studied using wire myography. Protein and mRNA expression, superoxide anion (O2•−) production and ET-1 plasma concentration were evaluated by immunofluorescence, real-time quantitative PCR, ethidium fluorescence and elisa, respectively. KEY RESULTS I/R increased ET-1 plasma concentration, ET-1-mediated vasoconstriction and ETB mRNA expression, and down-regulated ETA mRNA expression. Immunofluorescence confirmed mRNA results and revealed an increase in ETB receptors in the mesenteric resistance artery media layer after I/R. Therefore, the ETB receptor agonist sarafotoxin-6 induced a contraction that was inhibited by the ETB receptor antagonist BQ788 only in vessels, with and without endothelium, from I/R rats. Furthermore, BQ788 potentiated ET-1 vasoconstriction only in sham rats. Endothelium removal in rings from I/R rats unmasked the inhibition of ET-1 vasoconstriction by BQ788. Endothelium removal, Nω-nitro-L-arginine methyl ester and superoxide dismutase abolished the differences in ET-1 vasoconstriction between sham and I/R rats. We also found that I/R down-regulates endothelial NOS mRNA expression and concomitantly enhanced O2•− production by increasing NADPH oxidase 1 (NOX-1) and p47phox mRNA. CONCLUSIONS AND IMPLICATIONS Mesenteric I/R potentiated the ET-1-mediated vasoconstriction by a mechanism that involves up-regulation of muscular ETB receptors and decrease in NO bioavailability. PMID:21806604

Exercise training improves hemodynamic recovery to isometric exercise in obese men with type 2 diabetes but not in obese women.

PubMed

Kanaley, Jill A; Goulopoulou, Styliani; Franklin, Ruth; Baynard, Tracy; Carhart, Robert L; Weinstock, Ruth S; Fernhall, Bo

2012-12-01

Women with type 2 diabetes (T2D) show greater rates of mortality due to ischemic heart disease than men with T2D. We aimed to examine cardiovascular and autonomic function responses to isometric handgrip (IHG) exercise between men and women with T2D, before and after an exercise training program. Hemodynamic responses were measured in 22 men and women with T2D during and following a 3-min IHG test, and before and after 16 wks of aerobic exercise training. Women had a smaller decrease in mean arterial pressure (MAP) and systolic blood pressure (BP) during recovery from IHG (ΔMAP(REC)) than men pre- and post-training (P<0.05). Men showed a greater reduction in diastolic BP during recovery from IHG (P<0.05), and exercise training improved this response in men but not in women (men, pre-training: -13.9±1.8, post-training: -20.5±5.3 mmHg vs. women, pre-training: -10.7±1.7, post-training: -4.1±4.9 mmHg; P<0.05). Men had a greater reduction in sympathetic modulation of vasomotor tone (P<0.05), as estimated by blood pressure variability, following IHG. This response was accentuated after training, while this training effect was not seen in women. Post-training ΔMAP(REC) was correlated with recovery of low frequency component of the BP spectrum (ΔLF(SBPrec), r=0.52, P<0.05). Differences in BP recovery immediately following IHG may be attributed to gender differences in cardiovascular autonomic modulation. An improvement in these responses occurs following aerobic exercise training in obese men, but not in obese women with T2D which reflects a better adaptive autonomic response to exercise training. Copyright © 2012 Elsevier Inc. All rights reserved.

Imbalance of caveolin-1 and eNOS expression in the pulmonary vasculature of experimental diaphragmatic hernia.

PubMed

Hofmann, Alejandro; Gosemann, Jan-Hendrik; Takahashi, Toshiaki; Friedmacher, Florian; Duess, Johannes W; Puri, Prem

2014-08-01

Caveolin-1 (Cav-1) exerts major regulatory functions on intracellular signaling pathways originating at the plasma membrane. Cav-1 is a key regulator in adverse lung remodeling and the development of pulmonary hypertension (PH) regulating vasomotor tone through its ability to reduce nitric oxide (NO) production. This low-output endothelial NO synthase (eNOS) derived NO maintains normal pulmonary vascular homeostasis. Cav-1 deficiency leads to increased bioavailability of NO, which has been linked to increased nitrosative stress. Inhibition of eNOS reduced oxidant production and reversed PH, supporting the concept that Cav-1 regulation of eNOS activity is crucial to endothelial homeostasis in lungs. We designed this study to investigate the hypothesis that expression of Cav-1 is downregulated while eNOS expression is upregulated by the pulmonary endothelium in the nitrofen-induced congenital diaphragmatic hernia (CDH). Pregnant rats were exposed to nitrofen or vehicle on day 9.5 (D9.5). Fetuses were sacrificed on D21 and divided into nitrofen and control groups. Quantitative real-time polymerase chain reaction, Western blotting, and confocal immunofluorescence were performed to determine pulmonary gene expression levels and protein expression of Cav-1 and eNOS. Pulmonary Cav-1 gene expression levels were significantly decreased, while eNOS gene expression was significantly increased in nitrofen-induced CDH(+). Western blotting and confocal microscopy revealed decreased pulmonary Cav-1 protein expression, while eNOS protein expression was increased in CDH(+) compared to controls. The striking evidence of markedly decreased gene and protein expression of Cav-1 with concurrently increased eNOS gene and protein expression in the pulmonary vasculature suggests that activation of eNOS secondary to Cav-1 deficiency may play an important role in the pathogenesis of PH in the nitrofen-induced CDH. © 2014 Wiley Periodicals, Inc.

Gap Junction Regulation of Vascular Tone: Implications of Modulatory Intercellular Communication During Gestation

PubMed Central

Ampey, Bryan C.; Morschauser, Timothy J.; Lampe, Paul D.

2017-01-01

In the vasculature, gap junctions (GJ) play a multifaceted role by serving as direct conduits for cell–cell intercellular communication via the facilitated diffusion of signaling molecules. GJs are essential for the control of gene expression and coordinated vascular development in addition to vascular function. The coupling of endothelial cells to each other, as well as with vascular smooth muscle cells via GJs, plays a relevant role in the control of vasomotor tone, tissue perfusion and arterial blood pressure. The regulation of cell-signaling is paramount to cardiovascular adaptations of pregnancy. Pregnancy requires highly developed cell-to-cell coupling, which is affected partly through the formation of intercellular GJs by Cx43, a gap junction protein, within adjacent cell membranes to help facilitate the increase of uterine blood flow (UBF) in order to ensure adequate perfusion for nutrient and oxygen delivery to the placenta and thus the fetus. One mode of communication that plays a critical role in regulating Cx43 is the release of endothelial-derived vasodilators such as prostacyclin (PGI2) and nitric oxide (NO) and their respective signaling mechanisms involving second messengers (cAMP and cGMP, respectively) that are likely to be important in maintaining UBF. Therefore, the assertion we present in this review is that GJs play an integral if not a central role in maintaining UBF by controlling rises in vasodilators (PGI2 and NO) via cyclic nucleotides. In this review, we discuss: (1) GJ structure and regulation; (2) second messenger regulation of GJ phosphorylation and formation; (3) pregnancy-induced changes in cell-signaling; and (4) the role of uterine arterial endothelial GJs during gestation. These topics integrate the current knowledge of this scientific field with interpretations and hypotheses regarding the vascular effects that are mediated by GJs and their relationship with vasodilatory vascular adaptations required for modulating the dramatic physiological rises in uteroplacental perfusion and blood flow observed during normal pregnancy. PMID:25015806

Contribution of KV1.5 Channel to H2O2-Induced Human Arteriolar Dilation and its Modulation by Coronary Artery Disease

PubMed Central

Nishijima, Yoshinori; Cao, Sheng; Chabowski, Dawid S.; Korishettar, Ankush; Ge, Alyce; Zheng, Xiaodong; Sparapani, Rodney; Gutterman, David D.; Zhang, David X.

2016-01-01

Rationale Hydrogen peroxide (H2O2) regulates vascular tone in the human microcirculation under physiological and pathophysiological conditions. It dilates arterioles by activating BKCa channels in subjects with coronary artery disease (CAD), but its mechanisms of action in subjects without CAD (non-CAD) as compared to those with CAD remain unknown. Objective We hypothesize that H2O2-elicited dilation involves different K+ channels in non-CAD versus CAD, resulting in an altered capacity for vasodilation during disease. Methods and Results H2O2 induced endothelium-independent vasodilation in non-CAD adipose arterioles, which was reduced by paxilline, a BKCa channel blocker, and by 4-AP, a KV channel blocker. Assays of mRNA transcripts, protein expression and subcellular localization revealed that KV1.5 is the major KV1 channel expressed in vascular smooth muscle cells (VSMCs) and is abundantly localized on the plasma membrane. The selective KV1.5 blocker DPO-1 and the KV1.3/1.5 blocker Psora-4 reduced H2O2-elicited dilation to a similar extent as 4-AP, but the selective KV1.3 blocker PAP-1 was without effect. In arterioles from CAD subjects, H2O2-induced dilation was significantly reduced and this dilation was inhibited by paxilline but not by 4-AP, DPO-1 or Psora-4. KV1.5 cell membrane localization and DPO-1-sensitive K+ currents were markedly reduced in isolated VSMCs from CAD arterioles, although mRNA or total cellular protein expression were largely unchanged. Conclusions In human arterioles, H2O2-induced dilation is impaired in CAD, which is associated with a transition from a combined BKCa- and KV (KV1.5)-mediated vasodilation toward a BKCa-predominant mechanism of dilation. Loss of KV1.5 vasomotor function may play an important role in microvascular dysfunction in CAD or other vascular diseases. PMID:27872049

RNA-Seq Analysis of Abdominal Fat in Genetically Fat and Lean Chickens Highlights a Divergence in Expression of Genes Controlling Adiposity, Hemostasis, and Lipid Metabolism

PubMed Central

Resnyk, Christopher W.; Chen, Chuming; Huang, Hongzhan; Wu, Cathy H.; Simon, Jean; Le Bihan-Duval, Elisabeth; Duclos, Michel J.; Cogburn, Larry A.

2015-01-01

Genetic selection for enhanced growth rate in meat-type chickens (Gallus domesticus) is usually accompanied by excessive adiposity, which has negative impacts on both feed efficiency and carcass quality. Enhanced visceral fatness and several unique features of avian metabolism (i.e., fasting hyperglycemia and insulin insensitivity) mimic overt symptoms of obesity and related metabolic disorders in humans. Elucidation of the genetic and endocrine factors that contribute to excessive visceral fatness in chickens could also advance our understanding of human metabolic diseases. Here, RNA sequencing was used to examine differential gene expression in abdominal fat of genetically fat and lean chickens, which exhibit a 2.8-fold divergence in visceral fatness at 7 wk. Ingenuity Pathway Analysis revealed that many of 1687 differentially expressed genes are associated with hemostasis, endocrine function and metabolic syndrome in mammals. Among the highest expressed genes in abdominal fat, across both genotypes, were 25 differentially expressed genes associated with de novo synthesis and metabolism of lipids. Over-expression of numerous adipogenic and lipogenic genes in the FL chickens suggests that in situ lipogenesis in chickens could make a more substantial contribution to expansion of visceral fat mass than previously recognized. Distinguishing features of the abdominal fat transcriptome in lean chickens were high abundance of multiple hemostatic and vasoactive factors, transporters, and ectopic expression of several hormones/receptors, which could control local vasomotor tone and proteolytic processing of adipokines, hemostatic factors and novel endocrine factors. Over-expression of several thrombogenic genes in abdominal fat of lean chickens is quite opposite to the pro-thrombotic state found in obese humans. Clearly, divergent genetic selection for an extreme (2.5–2.8-fold) difference in visceral fatness provokes a number of novel regulatory responses that govern growth and metabolism of visceral fat in this unique avian model of juvenile-onset obesity and glucose-insulin imbalance. PMID:26445145

Bioresorbable scaffolds for percutaneous coronary interventions

PubMed Central

Gogas, Bill D.

2014-01-01

Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up). The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES). Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics were recently developed. These devices have been utilized in selected clinical applications providing preliminary evidence of safety showing comparable intermediate term clinical outcomes with current generation drug-eluting stents. PMID:25780795

The Effects of Gonadotropin-Releasing Hormone Agonist Combined with Add-Back Therapy on Quality of Life for Adolescents with Endometriosis: A Randomized Controlled Trial.

PubMed

Sadler Gallagher, Jenny; Feldman, Henry A; Stokes, Natalie A; Laufer, Marc R; Hornstein, Mark D; Gordon, Catherine M; DiVasta, Amy D

2017-04-01

Use of gonadotropin-releasing hormone agonists (GnRHa) to treat endometriosis can cause mood and vasomotor side effects. "Add-back therapy," the combination of low-dose hormones, limits side effects but research is limited to adults. We sought to characterize quality of life (QOL) before treatment and to compare an add-back regimen of norethindrone acetate (NA) with conjugated estrogens (CEE) to NA alone for preventing side effects of GnRHa therapy in female adolescents with endometriosis. Twelve-month double-blind, placebo-controlled trial. Pediatric Gynecology clinic in Boston, Massachusetts. Fifty female adolescents (aged 15-22 years) with surgically confirmed endometriosis initiating treatment with GnRHa. Subjects were randomized to: NA (5 mg/d) with CEE (0.625 mg/d) or NA (5 mg/d) with placebo. All subjects received leuprolide acetate depot every 3 months. The Short Form-36 v2 Health Survey, Beck Depression Inventory II, and Menopause Rating Scale were completed at repeated intervals. At baseline, subjects reported impaired physical health-related QOL compared with national norms (all P < .0001). Over 12 months, these Short Form-36 v2 scores improved (all P < .05). Subjects receiving NA with CEE showed greater improvements in the pain, vitality, and physical health subscales (P between groups < .05) than those receiving NA alone, as well as better physical functioning (P < .05). There were no changes in depression or menopause-like symptoms in either group. Female adolescents with endometriosis initiating GnRHa therapy have impaired QOL. Treatment with GnRHa combined with add-back therapy led to improved QOL, with no worsening of mood or menopausal side effects. NA with CEE was superior to NA alone for improving physical health-related QOL. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Decreased contractile response of peripheral arterioles to serotonin after CPB in patients with diabetes.

PubMed

Sabe, Sharif A; Feng, Jun; Liu, Yuhong; Scrimgeour, Laura A; Ehsan, Afshin; Sellke, Frank W

2018-05-11

Regulation of coronary vasomotor tone by serotonin is significantly changed after cardioplegic arrest and reperfusion. The current study investigates whether cardiopulmonary bypass may also affect peripheral arteriolar response to serotonin in patients with or without diabetes. Human peripheral microvessels (90-180 µm diameter) were dissected from harvested skeletal muscle tissues from diabetic and non-diabetic patients before and after cardiopulmonary bypass and cardiac surgery (n = 8/group). In vitro contractile response to serotonin was assessed by videomicroscopy in the presence or absence of serotonin alone (10 -9 -10 -5 M) or combined with the selective serotonin 1B receptor (5-HT1B) antagonist, SB224289 (10 -6 M). 5-HT1A/1B protein expression in the skeletal muscle was measured by Western-blot and immunohistochemistry. There were no significant differences in contractile response of peripheral arterioles to serotonin (10 -5 M) pre-cardiopulmonary bypass between diabetic and non-diabetic patients. After cardiopulmonary bypass, contractile response to serotonin was significantly impaired in both diabetic and non-diabetic patients compared to their pre-cardiopulmonary bypass counterparts (P < .05). This effect was more pronounced in diabetic patients than non-diabetic patients (P < .05 versus non-diabetic). The contractile response to serotonin was significantly inhibited by the 5-HT1B antagonist in both diabetic and non-diabetic vessels (P < .05 versus serotonin alone). There were no significant differences in the expression/distribution of 5-HT1A/1B between non-diabetic and diabetic groups or between pre- versus post- cardiopulmonary bypass vessels. Cardiopulmonary bypass is associated with decreased contractile response of peripheral arterioles to serotonin and this effect was exaggerated in the presence of diabetes. Serotonin-induced contractile response of the peripheral arterioles was via 5-HT1B in both diabetic and non-diabetic patients. Copyright © 2018 Elsevier Inc. All rights reserved.

A randomised, double-blind trial comparing raloxifene HCl and continuous combined hormone replacement therapy in postmenopausal women: effects on compliance and quality of life.

PubMed

Voss, Simon; Quail, Deborah; Dawson, Alison; Bäckström, Tjorbörn; Aguas, Fernanda; Erenus, Mithat; The, Hok Sien; Bonnar, John; De Geyter, Christian; Hunter, Myra; Nickelsen, Thomas

2002-08-01

To compare continuous combined hormone replacement therapy (ccHRT) and raloxifene with respect to compliance and quality of life, which were predefined secondary endpoints of a large, prospective study designed to investigate the uterine effects of both treatments. Double-blind, randomised controlled trial of six-month duration. One hundred and twenty-nine gynaecology hospital departments, clinics or practices specialised in women's healthcare, located in Europe, South Africa and Israel. Healthy postmenopausal women (n = 1008). Changes in quality of life using the Women's Health Questionnaire (WHQ) and compliance using a compliance questionnaire and pill count. Adverse event and early discontinuation rates and satisfaction with treatment using a visual analogue scale (VAS). Women taking raloxifene reported greater satisfaction with their treatment as assessed on the VAS (P = 0.004), and a lower proportion, as compared with ccHRT, reported being worried by the treatment (9.6% vs 20.2%, P < 0.01). Women taking ccHRT reported greater deterioration in scores from the WHQ for depressed mood and menstrual symptoms than those taking raloxifene (P < 0.01). For memory, vasomotor symptoms and sexual behaviour, the ccHRT group reported significantly greater mean improvements (P < 0.05). Over half (58.8%) of those taking raloxifene noticed no effect, 37.7% felt better and 3.4% felt worse as measured using the compliance questionnaire. Fifty percent of the women taking ccHRT felt better, 37.8% noticed no effect but over 10% felt worse. More women on raloxifene (94.6%) than on ccHRT (85.9%) reported that they were taking their double-blinded medication regularly (P < 0.01). A lower rate of adverse event-related discontinuations, the lack of negative effects on quality of life and a smaller proportion of women being worried by the drug treatment were associated with higher treatment satisfaction and better compliance in postmenopausal women taking ccHRT or raloxifene.

Specific adverse events predict survival benefit in patients treated with tamoxifen or aromatase inhibitors: an international tamoxifen exemestane adjuvant multinational trial analysis.

PubMed

Fontein, Duveken B Y; Seynaeve, Caroline; Hadji, Peyman; Hille, Elysée T M; van de Water, Willemien; Putter, Hein; Kranenbarg, Elma Meershoek-Klein; Hasenburg, Annette; Paridaens, Robert J; Vannetzel, Jean-Michel; Markopoulos, Christos; Hozumi, Yasuo; Bartlett, John M S; Jones, Stephen E; Rea, Daniel William; Nortier, Johan W R; van de Velde, Cornelis J H

2013-06-20

Specific adverse events (AEs) associated with endocrine therapy and related to depletion or blocking of circulating estrogens may be related to treatment efficacy. We investigated the relationship between survival outcomes and specific AEs including vasomotor symptoms (VMSs), musculoskeletal adverse events (MSAEs), and vulvovaginal symptoms (VVSs) in postmenopausal patients with breast cancer participating in the international Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial. Primary efficacy end points were disease-free survival (DFS), overall survival (OS), and distant metastases (DM). VMSs, MSAEs, and VVSs arising in the first year of endocrine treatment were considered. Patients who did not start or who discontinued their allocated therapy and/or had an event (recurrence/death) within 1 year after randomization were excluded. Landmark analyses and time-dependent multivariate Cox proportional hazards models assessed survival differences up to 5 years from the start of treatment. A total of 9,325 patients were included. Patients with specific AEs (v nonspecific or no AEs) had better DFS and OS (multivariate hazard ratio [HR] for DFS: VMSs, 0.731 [95% CI, 0.618 to 0.866]; MSAEs, 0.826 [95% CI, 0.694 to 0.982]; VVSs, 0.769 [95% CI, 0.585 to 1.01]; multivariate HR for OS: VMSs, 0.583 [95% CI, 0.424 to 0.803]; MSAEs, 0.811 [95% CI, 0.654 to 1.005]; VVSs, 0.570 [95% CI, 0.391 to 0.831]) and fewer DM (VMSs, 0.813 [95% CI, 0.664 to 0.996]; MSAEs, 0.749 [95% CI, 0.601 to 0.934]; VVSs, 0.687 [95% CI, 0.436 to 1.085]) than patients not reporting these symptoms. Increasing numbers of specific AEs were also associated with better survival outcomes. Outcomes were unrelated to treatment allocation. Certain specific AEs are associated with superior survival outcomes and may therefore be useful in predicting treatment responses in patients with breast cancer treated with endocrine therapy.

The effect of ethnicity on the vascular responses to cold exposure of the extremities.

PubMed

Maley, Matthew J; Eglin, Clare M; House, James R; Tipton, Michael J

2014-11-01

Cold injuries are more prevalent in individuals of African descent (AFD). Therefore, we investigated the effect of extremity cooling on skin blood flow (SkBF) and temperature (T sk) between ethnic groups. Thirty males [10 Caucasian (CAU), 10 Asian (ASN), 10 AFD] undertook three tests in 30 °C air whilst digit T sk and SkBF were measured: (i) vasomotor threshold (VT) test--arm immersed in 35 °C water progressively cooled to 10 °C and rewarmed to 35 °C to identify vasoconstriction and vasodilatation; (ii) cold-induced vasodilatation (CIVD) test--hand immersed in 8 °C water for 30 min followed by spontaneous warming; (iii) cold sensitivity (CS) test--foot immersed in 15 °C water for 2 min followed by spontaneous warming. Cold sensory thresholds of the forearm and finger were also assessed. In the VT test, vasoconstriction and vasodilatation occurred at a warmer finger T sk in AFD during cooling [21.2 (4.4) vs. 17.0 (3.1) °C, P = 0.034] and warming [22.0 (7.9) vs. 12.1 (4.1) °C, P = 0.002] compared with CAU. In the CIVD test, average SkBF during immersion was greater in CAU [42 (24) %] than ASN [25 (8) %, P = 0.036] and AFD [24 (13) %, P = 0.023]. Following immersion, SkBF was higher and rewarming faster in CAU [3.2 (0.4) °C min(-1)] compared with AFD [2.5 (0.7) °C min(-1), P = 0.037], but neither group differed from ASN [3.0 (0.6) °C min(-1)]. Responses to the CS test and cold sensory thresholds were similar between groups. AFD experienced a more intense protracted finger vasoconstriction than CAU during hand immersion, whilst ASN experienced an intermediate response. This greater sensitivity to cold may explain why AFD are more susceptible to cold injuries.

Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II.

PubMed

Smart, Keith M; Wand, Benedict M; O'Connell, Neil E

2016-02-24

Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery. When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturbances in sympathetically-mediated vasomotor control, together with maladaptive peripheral and central neuronal plasticity. CRPS can be classified into two types: type I (CRPS I) in which a specific nerve lesion has not been identified, and type II (CRPS II) where there is an identifiable nerve lesion. Guidelines recommend the inclusion of a variety of physiotherapy interventions as part of the multimodal treatment of people with CRPS, although their effectiveness is not known. To determine the effectiveness of physiotherapy interventions for treating the pain and disability associated with CRPS types I and II. We searched the following databases from inception up to 12 February 2015: CENTRAL (the Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, PEDro, Web of Science, DARE and Health Technology Assessments, without language restrictions, for randomised controlled trials (RCTs) of physiotherapy interventions for treating pain and disability in people CRPS. We also searched additional online sources for unpublished trials and trials in progress. We included RCTs of physiotherapy interventions (including manual therapy, therapeutic exercise, electrotherapy, physiotherapist-administered education and cortically directed sensory-motor rehabilitation strategies) employed in either a stand-alone fashion or in combination, compared with placebo, no treatment, another intervention or usual care, or of varying physiotherapy interventions compared with each other in adults with CRPS I and II. Our primary outcomes of interest were patient-centred outcomes of pain intensity and functional disability. Two review authors independently evaluated those studies identified through the electronic searches for eligibility and subsequently extracted all relevant data from the included RCTs. Two review authors independently performed 'Risk of bias' assessments and rated the quality of the body of evidence for the main outcomes using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We included 18 RCTs (739 participants) that tested the effectiveness of a broad range of physiotherapy-based interventions. Overall, there was a paucity of high quality evidence concerning physiotherapy treatment for pain and disability in people with CRPS I. Most included trials were at 'high' risk of bias (15 trials) and the remainder were at 'unclear' risk of bias (three trials). The quality of the evidence was very low or low for all comparisons, according to the GRADE approach.We found very low quality evidence that graded motor imagery (GMI; two trials, 49 participants) may be useful for improving pain (0 to 100 VAS) (mean difference (MD) -21.00, 95% CI -31.17 to -10.83) and functional disability (11-point numerical rating scale) (MD 2.30, 95% CI 1.12 to 3.48), at long-term (six months) follow-up, in people with CRPS I compared to usual care plus physiotherapy; very low quality evidence that multimodal physiotherapy (one trial, 135 participants) may be useful for improving 'impairment' at long-term (12 month) follow-up compared to a minimal 'social work' intervention; and very low quality evidence that mirror therapy (two trials, 72 participants) provides clinically meaningful improvements in pain (0 to 10 VAS) (MD 3.4, 95% CI -4.71 to -2.09) and function (0 to 5 functional ability subscale of the Wolf Motor Function Test) (MD -2.3, 95% CI -2.88 to -1.72) at long-term (six month) follow-up in people with CRPS I post stroke compared to placebo (covered mirror).There was low to very low quality evidence that tactile discrimination training, stellate ganglion block via ultrasound and pulsed electromagnetic field therapy compared to placebo, and manual lymphatic drainage combined with and compared to either anti-inflammatories and physical therapy or exercise are not effective for treating pain in the short-term in people with CRPS I. Laser therapy may provide small clinically insignificant, short-term, improvements in pain compared to interferential current therapy in people with CRPS I.Adverse events were only rarely reported in the included trials. No trials including participants with CRPS II met the inclusion criteria of this review. The best available data show that GMI and mirror therapy may provide clinically meaningful improvements in pain and function in people with CRPS I although the quality of the supporting evidence is very low. Evidence of the effectiveness of multimodal physiotherapy, electrotherapy and manual lymphatic drainage for treating people with CRPS types I and II is generally absent or unclear. Large scale, high quality RCTs are required to test the effectiveness of physiotherapy-based interventions for treating pain and disability of people with CRPS I and II. Implications for clinical practice and future research are considered.

Most bothersome symptom in women with genitourinary syndrome of menopause as a moderator of treatment effects.

PubMed

Pinkerton, JoAnn V; Bushmakin, Andrew G; Abraham, Lucy; Cappelleri, Joseph C; Komm, Barry S

2016-10-01

Conjugated estrogens/bazedoxifene (CE/BZA) is indicated to treat moderate/severe menopausal vasomotor symptoms and prevent postmenopausal osteoporosis. This analysis examines the impact of the most bothersome vaginal symptom at baseline on effects of CE/BZA. This post hoc analysis used data from a 12-week clinical trial of nonhysterectomized postmenopausal women (n = 664) randomly assigned to double-blind treatment with CE/BZA (0.45/20 mg and 0.625/20 mg), BZA 20 mg, or placebo. At baseline, women indicated which moderate/severe vaginal symptom (dryness, itching/irritation, or pain with intercourse) bothered them most. Repeated measures models were used to explore treatment effects in relationship to the most bothersome symptom. We calculated effect sizes for treatment differences versus placebo (effect sizes: trivial, 0.1; small, 0.2; medium, 0.5; large, 0.8). At baseline, 52% of women selected pain with intercourse, 35% selected vaginal dryness, and 13% selected vaginal itching/irritation as most bothersome. For these three symptom groups respectively, CE/BZA was associated with statistically significant improvements in Menopause-Specific Quality of Life sexual functioning (effect size: 0.45/20 mg, -0.36, -0.30, -0.67; 0.625/20 mg, -0.37, -0.40, -0.26) and/or overall score (effect size: 0.45/20 mg, -0.29, -0.41, -0.78; 0.625/20 mg, -0.41, -0.48, -0.68). Both those doses significantly improved the ease of lubrication item on the Arizona Sexual Experiences Scale in those with pain with intercourse (effect size: 0.45/20 mg, -0.43; 0.625/20 mg, -0.50) and produced some statistically significant improvements in vaginal cell counts in women with dryness or pain with intercourse as the most bothersome symptom. The higher dose was associated with greater treatment satisfaction on the Menopause Symptoms Treatment Satisfaction Questionnaire versus placebo in women who selected pain with intercourse (effect size: 0.40) or dryness (effect size: 0.43) as most bothersome. The approved dose of CE/BZA had clear benefits, particularly in women with pain with intercourse (the most common bothersome symptom), in whom it improved lubrication, superficial cell counts, and sexual functioning.

Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy.

PubMed

Shehab, Dia; Elgazzar, Abdelhamid; Collier, B David; Naddaf, Sleiman; Al-Jarallah, Khalid; Omar, Abdelmoneim; Al-Mutairy, Moudi

2006-01-01

To determine the impact of three-phase bone scintigraphy (TPBS) on the diagnosis and management of complex regional pain syndrome type I (CRPSI) or reflex sympathetic dystrophy (RSD). Twenty consecutive patients with a recent clinical evidence of CRPSI were referred for TPBS as part of their routine management plan. All patients underwent neurological examinations with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor and sensory dysfunction. Patients were followed prospectively. When both the clinical and TPBS results supported the diagnosis of CRPSI, patients were started on treatment. Of the 20 patients, TPBS supported the diagnosis of RSD in 9 who were treated with steroids and physiotherapy. Complete follow-up was available for 7 of them and all had a satisfactory response to treatment. For the remaining 11 patients RSD was diagnosed clinically but not confirmed by TPBS. On follow-up there was no evidence that TPBS failed to identify RSD in these 11 patients. The results indicate that TPBS confirmed the clinical diagnosis of RSD, and, more importantly, had a significant impact on its management.

Low-dose estrogen therapy for prevention of osteoporosis: working our way back to monotherapy.

PubMed

Richman, Susan; Edusa, Valentine; Fadiel, Ahmed; Naftolin, Frederick

2006-01-01

The risks of low bone mineral density, osteoporosis and fractures, are major concerns in postmenopausal women. Although postmenopausal hormone therapy is effective for reducing these risks, safety issues have been raised by the results of studies such as the Women's Health Initiative. Although there are scientifically valid reasons to be wary of the general applicability of the Women's Health Initiative findings, the study has underscored the continuing need for research into new forms of menopausal hormone therapy. Low-dose transdermal estrogen monotherapy can preserve bone density while relieving vasomotor symptoms. Transdermal administration may offer advantages, including lack of first-pass liver metabolism, which permits the use of lower doses and avoids a negative impact on the lipid profile. Moreover, a recently published 2-year study of ultra-low-dose transdermal estrogen monotherapy in an older population similar to that of the WHI reported significant increases in bone mineral density, accompanied by significant reductions in markers of bone turnover, with no increased risk of endometrial hyperplasia or other side effects. Additional studies are warranted to shed further light on the possible benefits of low-dose estrogen monotherapy for the prevention of bone loss in postmenopausal women.

Optoacoustic angiography of peripheral vasculature

NASA Astrophysics Data System (ADS)

Ermilov, Sergey; Su, Richard; Zamora, Mario; Hernandez, Travis; Nadvoretsky, Vyacheslav; Oraevsky, Alexander

2012-02-01

We developed a new optoacoustic microangiography system (OmAS) intended for in-vivo vascular imaging of a human finger. The system employs an arc-shaped acoustic array that is rotated 360 degrees around the finger providing optoacoustic data necessary for tomographic reconstruction of the three-dimensional images of a finger. A near-infrared Q-switched laser is used to generate optoacoustic signals with increased contrast of blood vessels. The laser is coupled through two randomized fiberoptic bundles oriented in orthogonal optoacoustic mode. To demonstrate OmAS capabilities, we present a time-series of optoacoustic images of a human finger taken after the hypothermia stress test. The images show a detailed vascular anatomy of a finger down to the capillary level. A series of quick 30s scans allowed us to visualize the thermoregulatory response within the studied finger as it was manifested via vasomotor activity during the hypothermia recovery. We propose that the developed system can be used for diagnostics of various medical conditions that are manifested in change of the peripheral (finger) blood flow. Examples of the medical conditions that could be diagnosed and staged using the OmAS include the peripheral arterial disease (PAD), thrombosis, frostbite, and traumas.

Intravascular hemolysis and the pathophysiology of sickle cell disease

PubMed Central

Kato, Gregory J.; Steinberg, Martin H.; Gladwin, Mark T.

2017-01-01

Hemolysis is a fundamental feature of sickle cell anemia that contributes to its pathophysiology and phenotypic variability. Decompartmentalized hemoglobin, arginase 1, asymmetric dimethylarginine, and adenine nucleotides are all products of hemolysis that promote vasomotor dysfunction, proliferative vasculopathy, and a multitude of clinical complications of pulmonary and systemic vasculopathy, including pulmonary hypertension, leg ulcers, priapism, chronic kidney disease, and large-artery ischemic stroke. Nitric oxide (NO) is inactivated by cell-free hemoglobin in a dioxygenation reaction that also oxidizes hemoglobin to methemoglobin, a non–oxygen-binding form of hemoglobin that readily loses heme. Circulating hemoglobin and heme represent erythrocytic danger-associated molecular pattern (eDAMP) molecules, which activate the innate immune system and endothelium to an inflammatory, proadhesive state that promotes sickle vaso-occlusion and acute lung injury in murine models of sickle cell disease. Intravascular hemolysis can impair NO bioavailability and cause oxidative stress, altering redox balance and amplifying physiological processes that govern blood flow, hemostasis, inflammation, and angiogenesis. These pathological responses promote regional vasoconstriction and subsequent blood vessel remodeling. Thus, intravascular hemolysis represents an intrinsic mechanism for human vascular disease that manifests clinical complications in sickle cell disease and other chronic hereditary or acquired hemolytic anemias. PMID:28248201

Fatal Small Intestinal Ischemia Due to Methamphetamine Intoxication: Report of a Case With Autopsy Results.

PubMed

Attaran, Hamid

2017-05-01

Methamphetamine is one of the most common abused drugs, so its various effects on different body organs should be familiar to all physicians. Regarding its gastrointestinal sequels, there are few reports of ischemic colitis induced by its vasoconstrictive effects. This is the first report of isolated small intestinal infarction resulting in death following methamphetamine toxicity. A 40-year-old woman with a past history of medical treatment for obesity referred to hospital with severe chest and back pain, perspiration, nausea, agitation, high blood pressure, bradycardia and subsequent lethargy and vasomotor instability. Cardiac evaluations were normal, and a toxicologic urinalysis revealed methamphetamine. Later, abdominal pain predominated, and ultrasonography revealed signs of bowel infarction. She did not consent to surgery and succumbed afterward. At autopsy gangrene and perforation of distal ileum were found. The cause of death was determined as intestinal gangrene following methamphetamine toxicity. Methamphetamine has anorectic effects and so is used in some "diet pills"; Consumers may not even know they are using methamphetamine. Hence in cases of either known MA abuse or those using unknown weight reduction drugs presenting with gastrointestinal complaints or abdominal pain, intestinal ischemia should be kept in mind and if plausible, intervened promptly.

Otorhinolaryngological problems in medical support of space flights.

PubMed

Bryanov, I I; Matsnev, E I; Yakovleva, I Y

1975-01-01

At present the main trends among the most important problems of otorhinolaryngology in space medicine have become defined as vestibulology, audiology and clinical aspects (prophylaxis, diagnosis and treatment of ENT diseases in flight). The principal result of recent vestibular studies has probably been the establishment of an apparent relationship between the resistance of the vestibular system to adequate ground-based stimulation and tolerance to space flight. The findings of the studies formed the basis for the development of a new system of vestibular selection, as well as demonstrated the usefulness of special vestibular training of astronauts by active and passive methods. In audiology certain urgency is acquired by the problem of noise limitation in space cabins and auditory system reliability prediction for preserving a high work capability in crew members. The hemodynamic changes in weightlessness, as well as the possibility for allergic lesions, create conditions for distorted course of the ENT diseases and vaso-motor disorders. The prophylaxis of aspirations also deserves close attention since the possibilities of their onset increase in weightlessness. The rendering of immediate, timely aid will depend not only on the presence of the necessary medical equipment but also on the ability of the crew members to render the appropriate otorhinolaryngological aid.

Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report.

PubMed

Apiliogullari, Seza; Aydin, Bahattin Kerem; Onal, Ozkan; Kirac, Yunus; Celik, Jale Bengi

2015-07-01

Complex regional pain syndrome (CRPS) is a painful and disabling syndrome in which the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Polio paralysis is caused by the damage or destruction of motor neurons in the spine, which lead to corresponding muscle paralysis. This report is a case report on the application of a pulsed radiofrequency (PRF) current to dorsal root ganglia (DRG) for the treatment of CRPS type 1 in an adolescent patient. Single case report. Selcuk University Hospital. A 16-year-old girl who suffered from CRPS type 1 secondary to surgeries for the sequelae of poliomyelitis. PRF current application to the lumbar 4 and lumbar 5 DRG. Pain reduction. The patient had complete resolution of her symptoms, which was maintained at a 6-month follow-up. This case illustrates that PRF applied to lumbar 4 and lumbar 5 DRG may play a significant role in CRPS type 1 management after the surgical treatment of poliomyelitis sequelae in adolescent patients. Further randomized, controlled studies are needed to support this argument. Wiley Periodicals, Inc.

Osmoregulation in Polycystic Kidney Disease: Relationship with Cystogenesis and Hypertension.

PubMed

Underwood, Conor F; Phillips, Jacqueline K; Hildreth, Cara M

2018-01-01

Polycystic kidney disease (PKD) is a group of monogenetic conditions characterised by the progressive accumulation of multiple renal cysts and hypertension. One of the earliest features of PKD is a reduction in urinary concentrating capacity that impairs extracellular fluid conservation. Urinary concentrating impairment predisposes PKD patients to periods of hypohydration when fluid loss is not adequately compensated by fluid intake. The hypohydrated state provides a blood hyperosmotic stimulus for vasopressin release to minimise further water loss. However, over-activation of renal V2 receptors contributes to cyst expansion. Although suppressing vasopressin release with high water intake has been shown to impair disease progression in rodent models, whether this approach is efficacious in patients remains uncertain. The neural osmoregulatory pathway that controls vasopressin secretion also exerts a stimulatory action on vasomotor sympathetic activity and blood pressure during dehydration. Recurrent dehydration leads to a worsening of hypertension in rodents and cross-sectional data suggests that reduced urinary concentrating ability may contribute to hypertension development in the clinical PKD population. Experimental studies are required to evaluate this hypothesis and to determine the underlying mechanism. © 2018 The Author(s) Published by S. Karger AG, Basel.

Role of ivabradine in management of stable angina in patients with different clinical profiles

PubMed Central

Kaski, Juan Carlos; Gloekler, Steffen; Ferrari, Roberto; Fox, Kim; Lévy, Bernard I; Komajda, Michel; Vardas, Panos; Camici, Paolo G

2018-01-01

In chronic stable angina, elevated heart rate contributes to the development of symptoms and signs of myocardial ischaemia by increasing myocardial oxygen demand and reducing diastolic perfusion time. Accordingly, heart rate reduction is a well-known strategy for improving both symptoms of myocardial ischaemia and quality of life (QOL). The heart rate-reducing agent ivabradine, a direct and selective inhibitor of the I f current, decreases myocardial oxygen consumption while increasing diastolic time, without affecting myocardial contractility or coronary vasomotor tone. Ivabradine is indicated for treatment of stable angina and chronic heart failure (HF). This review examines available evidence regarding the efficacy and safety of ivabradine in stable angina, when used as monotherapy or in combination with beta-blockers, in particular angina subgroups and in patients with stable angina with left ventricular systolic dysfunction (LVSD) or HF. Trials involving more than 45 000 patients receiving treatment with ivabradine have shown that this agent has antianginal and anti-ischaemic effects, regardless of age, sex, severity of angina, revascularisation status or comorbidities. This heart rate-lowering agent might also improve prognosis, reduce hospitalisation rates and improve QOL in angina patients with chronic HF and LVSD. PMID:29632676

Climacteric symptoms and their relation to feminine self-concept.

PubMed

Quiroga, A; Larroy, C; González-Castro, P

2017-06-01

To investigate women's subjective experiences in the climacteric transition, especially the impact of self-concept, quality of life and depression on the severity of climacteric symptoms. Non-experimental, cross-sectional study, purpose sampling. To analyze the results, we proposed a three-way interaction, in which the direct effect of depression on the severity of climacteric symptoms would be buffered by perceived sexual quality of life, and mediated by self-concept. As hypothesized, depression significantly predicted self-concept, which in turn mediated the severity of climacteric symptoms. In a second stage of the model, sexual quality of life moderated the direct effect of depression on climacteric symptoms, such that women with a better sexual quality of life would perceive less severity of climacteric symptoms than those with a less favorable sexual quality of life. Physical quality of life did not significantly buffer the direct effect of depression on climacteric symptoms, nor did vasomotor or psychosocial quality of life. Our study confirmed the impact of subjective factors such as satisfaction, self-concept, and quality of life on climacteric symptoms; specifically, we observed the moderating effect of the sexual quality of life on the previously established correlation between depression and aggravation of climacteric symptoms.

Contemporary Alternatives to Plant Estrogens for Menopause

PubMed Central

Geller, Stacie E.; Studee, Laura

2006-01-01

Objectives Every year, millions of women begin the peri-menopause and may experience a number of symptoms related to this transition. Many women are reluctant to use exogenous hormone therapy for treatment of menopausal symptoms and are turning to botanical and dietary supplements (BDS) for relief. This paper reviews the literature on alternatives to plant estrogens for relief of menopausal symptoms. Methods The MEDLINE database was searched for clinical trials of non-estrogenic plant extracts for menopausal symptoms. To be included, studies had to include peri- or postmenopausal women as subjects. All clinical trials (randomized-controlled trials, open trials, and comparison group studies) were included for this review. Results Black Cohosh appears to be one of the most effective botanicals for relief of vasomotor symptoms, while St. John’s wort can improve mood disorders related to the menopausal transition. Many other botanicals have limited evidence to demonstrate safety and efficacy for relief of symptoms related to menopause. Conclusions A growing body of evidence suggests that some botanicals and dietary supplements could result in improved clinical outcomes. Health care providers should discuss these issues with their patients so they can assist them in managing these alternative therapies through an evidence-based approach. PMID:16884867

Novel Immunohistochemical Techniques Using Discrete Signal Amplification Systems for Human Cutaneous Peripheral Nerve Fiber Imaging

PubMed Central

Wang, Ningshan; Gibbons, Christopher H.; Freeman, Roy

2011-01-01

Confocal imaging uses immunohistochemical binding of specific antibodies to visualize tissues, but technical obstacles limit more widespread use of this technique in the imaging of peripheral nerve tissue. These obstacles include same-species antibody cross-reactivity and weak fluorescent signals of individual and co-localized antigens. The aims of this study were to develop new immunohistochemical techniques for imaging of peripheral nerve fibers. Three-millimeter punch skin biopsies of healthy individuals were fixed, frozen, and cut into 50-µm sections. Tissues were stained with a variety of antibody combinations with two signal amplification systems, streptavidin-biotin-fluorochrome (sABC) and tyramide-horseradish peroxidase-fluorochrome (TSA), used simultaneously to augment immunohistochemical signals. The combination of the TSA and sABC amplification systems provided the first successful co-localization of sympathetic adrenergic and sympathetic cholinergic nerve fibers in cutaneous human sweat glands and vasomotor and pilomotor systems. Primary antibodies from the same species were amplified individually without cross-reactivity or elevated background interference. The confocal fluorescent signal-to-noise ratio increased, and image clarity improved. These modifications to signal amplification systems have the potential for widespread use in the study of human neural tissues. PMID:21411809

Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions

PubMed Central

Pachman, Deirdre R; Jones, Jason M; Loprinzi, Charles L

2010-01-01

Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block. PMID:21072305

Determination of Vascular Waterfall Phenomenon by Bedside Measurement of Mean Systemic Filling Pressure and Critical Closing Pressure in the Intensive Care Unit

PubMed Central

Maas, Jacinta J.; de Wilde, Rob B.; Aarts, Leon P.; Pinsky, Michael R.; Jansen, Jos R.

2012-01-01

Background Mean systemic filling pressure (Pmsf) can be determined at the bedside by measuring central venous pressure (Pcv) and cardiac output (CO) during inspiratory hold maneuvers. Critical closing pressure (Pcc) can be determined using the same method measuring arterial pressure (Pa) and CO. If Pcc > Pmsf there is then a vascular waterfall. In this study we assessed the existence of a waterfall and its implications for the calculation of vascular resistances by determining Pmsf and Pcc at the bedside. Methods In 10 mechanically ventilated postcardiac surgery patients inspiratory hold maneuvers were performed, transiently increasing Pcv and decreasing Pa and CO to four different steady-state levels. For each patient values of Pcv and CO were plotted in a venous return curve to determine Pmsf. Similarly, Pcc was determined with a ventricular output curve plotted for Pa and CO. Measurements were performed in each patient before and after volume expansion with 0.5 l colloid and vascular resistances were calculated. Results For every patient the relationship between the four measurements of Pcv and CO and of Pa and CO was linear. Baseline Pmsf was 18.7±4.0 (mean±SD) mmHg and differed significantly from Pcc 45.5±11.1 mmHg; (p<0.0001). The difference of Pcc and Pmsf was 26.8±10.7 mmHg, indicating the presence of a systemic vascular waterfall. Volume expansion increased Pmsf (26.3±3.2 mmHg), Pcc (51.5±9.0 mmHg) and CO (5.5±1.8 to 6.8±1.8 l·min−1). Arterial (upstream of Pcc) and venous (down-stream of Pmsf) vascular resistance were 8.27±4.45 and 2.75±1.23 mmHg·min·l−1; the sum of both (11.01 mmHg·min·l−1) was significantly different from total systemic vascular resistance (16.56±8.57 mmHg·min·l−1, p=0.005). Arterial resistance was related to total resistance. Conclusions Vascular pressure gradients in cardiac surgery patients suggest the presence of a vascular waterfall phenomenon, which is not affected by CO. Thus measures of total systemic vascular resistance may become irrelevant in assessing systemic vasomotor tone. PMID:22344243

p38 mitogen-activated protein kinase is involved in arginase-II-mediated eNOS-Uncoupling in Obesity

PubMed Central

2014-01-01

Background Endothelial nitric oxide synthase (eNOS)-uncoupling links obesity-associated insulin resistance and type-II diabetes to the increased incidence of cardiovascular disease. Studies have indicated that increased arginase is involved in eNOS-uncoupling through competing with the substrate L-arginine. Given that arginase-II (Arg-II) exerts some of its biological functions through crosstalk with signal transduction pathways, and that p38 mitogen-activated protein kinase (p38mapk) is involved in eNOS-uncoupling, we investigated here whether p38mapk is involved in Arg-II-mediated eNOS-uncoupling in a high fat diet (HFD)-induced obesity mouse model. Methods Obesity was induced in wild type (WT) and Arg-II-deficient (Arg-II-/-) mice on C57BL/6 J background by high-fat diet (HFD, 55% fat) for 14 weeks starting from age of 7 weeks. The entire aortas were isolated and subjected to 1) immunoblotting analysis of the protein level of eNOS, Arg-II and p38mapk activation; 2) arginase activity assay; 3) endothelium-dependent and independent vasomotor responses; 4) en face staining of superoxide anion and NO production with Dihydroethidium and 4,5-Diaminofluorescein Diacetate, respectively, to assess eNOS-uncoupling. To evaluate the role of p38mapk, isolated aortas were treated with p38mapk inhibitor SB203580 (10 μmol/L, 1 h) prior to the analysis. In addition, the role of p38mapk in Arg-II-induced eNOS-uncoupling was investigated in cultured human endothelial cells overexpressing Arg-II in the absence or presence of shRNA against p38mapk. Results HFD enhanced Arg-II expression/activity and p38mapk activity, which was associated with eNOS-uncoupling as revealed by decreased NO and enhanced L-NAME-inhibitable superoxide in aortas of WT obese mice. In accordance, WT obese mice revealed decreased endothelium-dependent relaxations to acetylcholine despite of higher eNOS protein level, whereas Arg-II-/- obese mice were protected from HFD-induced eNOS-uncoupling and endothelial dysfunction, which was associated with reduced p38mapk activation in aortas of the Arg-II-/- obese mice. Moreover, overexpression of Arg-II in human endothelial cells caused eNOS-uncoupling and augmented p38mapk activation. The Arg-II-induced eNOS-uncoupling was prevented by silencing p38mapk. Furthermore, pharmacological inhibition of p38mapk recouples eNOS in isolated aortas from WT obese mice. Conclusions Taking together, we demonstrate here for the first time that Arg-II causes eNOS-uncoupling through activation of p38 mapk in HFD-induced obesity. PMID:25034973

A statewide survey assessing practitioners' use and perceived utility of functional assessment.

PubMed

Roscoe, Eileen M; Phillips, Katurri M; Kelly, Maureen A; Farber, Rachel; Dube, William V

2015-12-01

The field of applied behavior analysis emphasizes the importance of conducting functional assessment before treatment development for problem behavior. There is, however, little information regarding the extent to which practitioners are using functional assessment in applied settings for individuals with developmental disabilities (DD). The purpose of the current study was to conduct a survey to assess the degree to which various types of functional assessment are implemented in agencies that serve individuals with DD in Massachusetts. Practitioners were asked to indicate their perception about and use of the various categories of functional assessment (e.g., indirect assessment, descriptive assessment, and functional analysis). From the 205 respondents who completed the survey, the most frequently used functional assessment was descriptive assessment. Results indicated that although the majority (67.8%) of practitioners believe functional analysis to be the most informative assessment tool for selecting behavioral treatment, only 34.6% of respondents indicated that they typically use functional analysis to inform the development of a behavior plan. © Society for the Experimental Analysis of Behavior.

MRI/DTI of the Brain Stem Reveals Reversible and Irreversible Disruption of the Baroreflex Neural Circuits: Clinical Implications

PubMed Central

Su, Chia-Hao; Tsai, Ching-Yi; Chang, Alice Y.W.; Chan, Julie Y.H.; Chan, Samuel H.H.

2016-01-01

Baroreflex is the physiological mechanism for the maintenance of blood pressure and heart rate. Impairment of baroreflex is not a disease per se. However, depending on severity, the eventuality of baroreflex dysfunction varies from inconvenience in daily existence to curtailment of mobility to death. Despite universal acceptance, neuronal traffic within the contemporary neural circuits during the execution of baroreflex has never been visualized. By enhancing signal detection and fine-tuning the scanning parameters, we have successfully implemented tractographic analysis of the medulla oblongata in mice that allowed for visualization of connectivity between key brain stem nuclei in the baroreflex circuits. When viewed in conjunction with radiotelemetric analysis of the baroreflex, we found that under pathophysiological conditions when the disrupted connectivity between key nuclei in the baroreflex circuits was reversible, the associated disease condition (e.g. neurogenic hypertension) was amenable to remedial measures. Nevertheless, fatality ensues under pathological conditions (e.g. hepatic encephalopathy) when the connectivity between key substrates in the baroreflex circuits was irreversibly severed. MRI/DTI also prompted partial re-wiring of the contemporary circuit for baroreflex-mediated sympathetic vasomotor tone, and unearthed an explanation for the time lapse between brain death and the inevitable asystole signifying cardiac death that follows. PMID:27162554

MRI/DTI of the Brain Stem Reveals Reversible and Irreversible Disruption of the Baroreflex Neural Circuits: Clinical Implications.

PubMed

Su, Chia-Hao; Tsai, Ching-Yi; Chang, Alice Y W; Chan, Julie Y H; Chan, Samuel H H

2016-01-01

Baroreflex is the physiological mechanism for the maintenance of blood pressure and heart rate. Impairment of baroreflex is not a disease per se. However, depending on severity, the eventuality of baroreflex dysfunction varies from inconvenience in daily existence to curtailment of mobility to death. Despite universal acceptance, neuronal traffic within the contemporary neural circuits during the execution of baroreflex has never been visualized. By enhancing signal detection and fine-tuning the scanning parameters, we have successfully implemented tractographic analysis of the medulla oblongata in mice that allowed for visualization of connectivity between key brain stem nuclei in the baroreflex circuits. When viewed in conjunction with radiotelemetric analysis of the baroreflex, we found that under pathophysiological conditions when the disrupted connectivity between key nuclei in the baroreflex circuits was reversible, the associated disease condition (e.g. neurogenic hypertension) was amenable to remedial measures. Nevertheless, fatality ensues under pathological conditions (e.g. hepatic encephalopathy) when the connectivity between key substrates in the baroreflex circuits was irreversibly severed. MRI/DTI also prompted partial re-wiring of the contemporary circuit for baroreflex-mediated sympathetic vasomotor tone, and unearthed an explanation for the time lapse between brain death and the inevitable asystole signifying cardiac death that follows.

Symmetricity analysis of time to peak parameter of indocyanine green dynamics

NASA Astrophysics Data System (ADS)

An, Yuri; Lee, Jungsul; Choi, Chulhee

2013-03-01

We have previously discovered that near-infrared optical imaging of indocyanine green (ICG) signal and analyzing its dynamics can be applied for measurement of blood perfusion rate and detection of Raynaud's phenomenon (RP). Especially, RP is closely associated with abnormal vasomotor responses and can progress to tissue necrosis due to excessively sustained vasoconstriction. Therefore, early detecting of RP is one of important implication to prevent tissue damage from peripheral vascular disorders. In the present study, we propose new analysis and scoring method of symmetricity of Tmax value of left and right extremities. Moreover, this symmetricity analysis can give further information about microvascular insufficiency. For validation of the proposed method, we tested whether the segmental and paired analysis of Tmax value (time-to-peak) of ICG dynamics can be used for sensitive diagnosis of microvascular abnormalities which cannot be detected by conventional methods. From the near-infrared images of diabetes mellitus patients with vascular complications, the trend of asymmetry in Tmax value was observed. We assumed that decreasing local blood perfusion by autonomic nerve dysfunction causes the asymmetric Tmax value of right and left feet. These results collectively indicate that the proposed method can be used as a useful diagnostic tool for RP or other microvascular disorders.

Comparison of IR thermography and thermocouple measurement of heat loss from rabbit pinna.

PubMed

Mohler, F S; Heath, J E

1988-02-01

The temperature of the pinnae of male New Zealand White rabbits was measured by use of infrared thermography. At ambient temperatures of 15, 20, and 25 degrees C, the average pinna temperatures were 23.0, 28.7, and 36.2 degrees C, respectively. From these temperatures, average heat loss from the total pinna surface area was calculated to be 2.8, 3.3, and 4.4 W, respectively. Preoptic temperature changes also affect the vasomotor state of the rabbit. At an ambient temperature of 20 degrees C, cooling the preoptic area of the rabbit by approximately 1 degree C resulted in an average pinna temperature of 26.5 degrees C and a heat loss of 2.4 W. Heating the preoptic area by approximately 1 degree C resulted in an average pinna temperature of 33.5 degrees C and a heat loss of 5.4 W. Finally, pinna temperatures were measured by use of a thermocouple and infrared thermography simultaneously. When the pinnae were vasodilated, the thermocouple measurements were consistently higher than the pinna surface temperatures measured thermographically. When the pinnae were vasoconstricted, the thermocouple measurements were consistently lower than the pinna surface temperatures measured thermographically. The discrepancy between the two methods of measurement is discussed.

The effect of (+)-lysergic acid diethylamide and other drugs on the carotid sinus reflex

PubMed Central

Ginzel, K. H.

1958-01-01

In cats, lysergic acid diethylamide (LSD) selectively blocked the reflex blood pressure rise following carotid chemoreceptor stimulation. It also reduced or abolished the chemoreceptor component of the pressor response to occlusion of the common carotid arteries. It did not inhibit the respiratory reflexes arising from the carotid chemoreceptors, unless spontaneous respiration was interfered with as a whole. The site of action was central, probably below the intercollicular level, regardless of whether the drug was administered by the intravenous route or into the lateral ventricle of the brain. LSD did not block the baroreceptor depressor reflex elicited by stimulation of one carotid sinus nerve. LSD frequently caused the systemic pressure to fall, even after vagotomy and atropine, and this effect might account for the occasional reduction of the baroreceptor component of the carotid occlusion response. On the other hand, no relationship was found between the action of LSD on vasomotor tone and its blocking effect on the chemoreceptor pressor reflex. Some derivatives of LSD produced effects similar to those described for LSD, whether or not they possessed a psychotropic action in man, and independently of their efficiency as antagonists to 5-hydroxytryptamine. Of a series of compounds chemically unrelated to LSD, chlorpromazine was found to block the chemoreceptor pressor rise after intracerebroventricular injection. PMID:13584725

[Skin and menopause].

PubMed

Bensaleh, H; Belgnaoui, F Z; Douira, L; Berbiche, L; Senouci, K; Hassam, B

2006-12-01

Important changes related to declining level of several hormones occur during menopause: vasomotor instability, bone loss, anxiety, sexual dysfunction, skin aging... Our objective was a review of the literature concerning the histological and clinical changes seen in post menopausal skin, and also an analysis of the effect of hormonal replacement therapy in slowing down the aging process. Decline in progesterone increases the impact of androgen on the sebaceous glands and hair. Decreased estrogen slows down mitotic activity in the epidermal basal layer, reduces the synthesis of collagen and contributes to thickening of the dermo-epidermal junction. This hypoestrogenemia may be spontaneously attenuated by local synthesis of oestradiol in peripheral target tissues according to the intracrine process. This new hormonal pattern is associated with skin atrophy, hyperseborrhea, increased pilosity on the cheeks and upper lip, loss of scalp hair, increase in degeneration of elastic tissue, atrophy and dryness of the vaginal mucosa. Estrogen treatment in post menopausal women has been shown to increase collagen content, dermal thickness and elasticity. Biophysical properties are also significantly improved for the parameters reflecting hydration and sebum secretion. However, numerous side effects such as increased incidence of cancer and cardiovascular morbidity limit the use of this treatment. So non hormonal alternatives are proposed. Laser and lifting remain the most important options.

The effect of (+)-lysergic acid diethylamide and other drugs on the carotid sinus reflex.

PubMed

GINZEL, K H

1958-09-01

In cats, lysergic acid diethylamide (LSD) selectively blocked the reflex blood pressure rise following carotid chemoreceptor stimulation. It also reduced or abolished the chemoreceptor component of the pressor response to occlusion of the common carotid arteries. It did not inhibit the respiratory reflexes arising from the carotid chemoreceptors, unless spontaneous respiration was interfered with as a whole. The site of action was central, probably below the intercollicular level, regardless of whether the drug was administered by the intravenous route or into the lateral ventricle of the brain.LSD did not block the baroreceptor depressor reflex elicited by stimulation of one carotid sinus nerve. LSD frequently caused the systemic pressure to fall, even after vagotomy and atropine, and this effect might account for the occasional reduction of the baroreceptor component of the carotid occlusion response. On the other hand, no relationship was found between the action of LSD on vasomotor tone and its blocking effect on the chemoreceptor pressor reflex.Some derivatives of LSD produced effects similar to those described for LSD, whether or not they possessed a psychotropic action in man, and independently of their efficiency as antagonists to 5-hydroxytryptamine. Of a series of compounds chemically unrelated to LSD, chlorpromazine was found to block the chemoreceptor pressor rise after intracerebroventricular injection.

Contraception and hormonal management in the perimenopause.

PubMed

Long, Margaret E; Faubion, Stephanie S; MacLaughlin, Kathy L; Pruthi, Sandhya; Casey, Petra M

2015-01-01

This literature review focuses on contraception in perimenopausal women. As women age, their fecundity decreases but does not disappear until menopause. After age 40, 75% of pregnancies are unplanned and may result in profound physical and emotional impact. Clinical evaluation must be relied on to diagnose menopause, since hormonal levels fluctuate widely. Until menopause is confirmed, some potential for pregnancy remains; at age 45, women's sterility rate is 55%. Older gravidas experience higher rates of diabetes, hypertension, and death. Many safe and effective contraceptive options are available to perimenopausal women. In addition to preventing an unplanned and higher-risk pregnancy, perimenopausal contraception may improve abnormal uterine bleeding, hot flashes, and menstrual migraines. Long-acting reversible contraceptives, including the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant (ESI), and the copper intrauterine device (Cu-IUD), provide high efficacy without estrogen. LNG-IUS markedly decreases menorrhagia commonly seen in perimenopause. Both ESI and LNG-IUS provide endometrial protection for women using estrogen for vasomotor symptoms. Women without cardiovascular risk factors can safely use combined hormonal contraception. The CDC's Medical Eligibility Criteria for Contraceptive Use informs choices for women with comorbidities. No medical contraindications exist for levonorgestrel emergency-contraceptive pills, though obesity does decrease efficacy. In contrast, the Cu-IUD provides reliable emergency and ongoing contraception regardless of body mass index (BMI).

[POEMS syndrome with plasmocytoma lytic bone lesion].

PubMed

Rafai, M A; Fadel, H; Boulaajaj, F Z; Sibai, M; Rafai, M; El Moutawakkil, B; Bourezgui, M; Trafeh, M; Slassi, I

2008-01-01

Crow-Fukase or Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin changes syndrome (POEMS) is a rare multisystemic affection with incompletely elucidated etiopathogenesis. We report a case of POEMS syndrome in a 48-year-old adult revealed four months before admission by areflexic flask tetraparesis prevalent on the lower limbs in connection with demyelinating and axonal CIDP "like" sensoriomotor neuropathy of the four limbs electroneuromyographically. The patient presented elevated protein level in the CSF with monoclonal standard IgG gammapathy associated with a narrow band lambda, suggesting POEMS syndrome. Further explorations revealed skin lesions with glomeruloid angiomas, edematous vasomotor disorders as well as erythrocyanose, hypogonadism, papillar edema and a lytic bone lesion of the left scapula. Radiotherapy was associated with corticosteroids and plasma exchanges. Outcome was good with resolution of the symptoms and stabilization of the neuropathy. POEMS syndrome is rare; the diagnosis is based on necessary criteria, the presence of a demyelinating and axonal polyneuropathy associated with an IgA or IgG monoclonal gammapathy, the light chain being almost entirely lambda, associated to other characteristic elements, in particular glomeruloid angiomas, endocrinopathy, sclerosing plasmocytoma which must be carefully required. Treatment is based on surgical cure or radiotherapy for bone lesion and non specific treatments such as corticosteroid therapy, plasma exchanges and IVIG.

Psychometric properties of a scale to measure menopause-related symptoms in two ethnicities.

PubMed

Wang, X; Perry, A C; Elbaum, B E; Burnett, K F; Swaminathan, H

2009-08-01

To evaluate the psychometric properties of a scale we constructed to measure menopause-related symptoms in Hispanic and White non-Hispanic women. Items were generated from the literature and clinical experiences. Hispanic (n = 123, 51.34 +/- 5.14 years) and White (n = 210, 53.36 +/- 4.80 years) women completed the scale and other instruments used to validate respective constructs. A subgroup of 69 women completed our scale a second time. Following exploratory factor analysis using the entire sample, confirmatory factor analysis was conducted for Hispanic and White women, separately. The same four-factor model (vasomotor, psychological symptoms, relationship(s), and other symptoms) fit data for both ethnic groups. The coefficient alpha for internal consistency was 0.852 and 0.849 for the initial and second administration, respectively, and the test-retest reliability was significant (p < 0.001). There were differences in factor scores among groups with different menopausal status. Factor scores were significantly correlated with scores of a global quality-of-life instrument (p < or = 0.001). Our study suggests that the scale is appropriate for use for Hispanic and White non-Hispanic women and is capable of detecting differences among women with different menopause-related symptoms. Menopause-related symptoms measured by the scale were correlated with global quality of life.

Differences in skin sympathetic involvements between two chronic autonomic disorders: multiple system atrophy and pure autonomic failure.

PubMed

Asahina, Masato; Akaogi, Yuichi; Yamanaka, Yoshitaka; Koyama, Yu; Hattori, Takamichi

2009-06-01

Certain stimuli evoke increased sweat secretion (sympathetic sweat response; SSwR) and reduced skin blood flow (skin vasomotor reflex; SkVR) in the palm/sole. We evaluated SSwR and SkVR in patients with multiple system atrophy (MSA) and pure autonomic failure (PAF). SSwR and SkVR on the palm in response to deep inspiration and mental arithmetic were recorded in 11 MSA patients, 11 PAF patients, and 11 healthy controls. In addition, the head-up tilt test was performed, and the coefficient of variation of R-R intervals (CV(R-R)) was obtained. SSwR amplitudes were significantly lower in the MSA and PAF patients than the controls. SkVR amplitudes in the PAF patients were significantly lower than the controls, but preserved in the MSA patients. In head-up tilt tests, all MSA and PAF patients showed orthostatic hypotension, with similar severity. CV(R-R) was low in the MSA and PAF patients, but a significant difference was found only between the PAF and control groups. In the MSA patients, SkVR was preserved, but SSwR was diminished. In the PAF patients, both SkVR and SSwR were attenuated. The combination of SkVR and SSwR tests may differentiate MSA and PAF.

Efficacy of paracetamol on patent ductus arteriosus closure may be dose dependent: evidence from human and murine studies.

PubMed

El-Khuffash, Afif; Jain, Amish; Corcoran, David; Shah, Prakesh S; Hooper, Christopher W; Brown, Naoko; Poole, Stanley D; Shelton, Elaine L; Milne, Ginger L; Reese, Jeff; McNamara, Patrick J

2014-09-01

We evaluated the clinical effectiveness of variable courses of paracetamol on patent ductus arteriosus (PDA) closure and examined its effect on the in vitro term and preterm murine ductus arteriosus (DA). Neonates received one of the following three paracetamol regimens: short course of oral paracetamol (SCOP), long course of oral paracetamol (LCOP), and intravenous paracetamol (IVP) for 2-6 d. Pressure myography was used to examine changes in vasomotor tone of the preterm and term mouse DA in response to paracetamol or indomethacin. Their effect on prostaglandin synthesis by DA explants was measured by mass spectroscopy. Twenty-one preterm infants were included. No changes in PDA hemodynamics were seen in SCOP infants (n = 5). The PDA became less significant and eventually closed in six LCOP infants (n = 7). PDA closure was achieved in eight IVP infants (n = 9). On pressure myograph, paracetamol induced a concentration-dependent constriction of the term mouse DA, up to 30% of baseline (P < 0.01), but required >1 µmol/l. Indomethacin induced greater DA constriction and suppression of prostaglandin synthesis (P < 0.05). The clinical efficacy of paracetamol on PDA closure may depend on the duration of treatment and the mode of administration. Paracetamol is less potent than indomethacin for constriction of the mouse DA in vitro.

Differences in the Pulsatile Component of the Skin Hemodynamic Response to Verbal Fluency Tasks in the Forehead and the Fingertip

PubMed Central

Takahashi, Toshimitsu; Takikawa, Yoriko; Kawagoe, Reiko

2016-01-01

Several studies have claimed that hemodynamic signals measured by near-infrared spectroscopy (NIRS) on the forehead exhibit different patterns during a verbal fluency task (VFT) in various psychiatric disorders, whereas many studies have noted that NIRS signals can reflect task-related changes in skin blood flow. If such a task-related skin hemodynamic response is also observed in the fingertip, a simpler biomarker may be developed. Furthermore, determining the difference in the response pattern may provide physiological insights into the condition. We found that the magnitude of the pulsatile component in skin hemodynamic signals increased on the forehead (p < 0.001 for N = 50, p = 0.073 for N = 8) but decreased on the fingertip (p < 0.001, N = 8) during the VFT, whereas the rate in both areas increased (p < 0.02, N = 8). We also did not find a repetition effect in both the rate and the magnitude on the fingertip, whereas the effect was present in the magnitude (p < 0.02, N = 8) but not in the rate on the forehead. These results suggest that the skin vasomotor system in the forehead could have a different vessel mechanism to psychological tasks compared to the fingertip. PMID:26905432

The Interplay between Inflammation, Coagulation and Endothelial Injury in the Early Phase of Acute Pancreatitis: Clinical Implications

PubMed Central

Dumnicka, Paulina; Maduzia, Dawid; Ceranowicz, Piotr; Olszanecki, Rafał; Drożdż, Ryszard; Kuśnierz-Cabala, Beata

2017-01-01

Acute pancreatitis (AP) is an inflammatory disease with varied severity, ranging from mild local inflammation to severe systemic involvement resulting in substantial mortality. Early pathologic events in AP, both local and systemic, are associated with vascular derangements, including endothelial activation and injury, dysregulation of vasomotor tone, increased vascular permeability, increased leukocyte migration to tissues, and activation of coagulation. The purpose of the review was to summarize current evidence regarding the interplay between inflammation, coagulation and endothelial dysfunction in the early phase of AP. Practical aspects were emphasized: (1) we summarized available data on diagnostic usefulness of the markers of endothelial dysfunction and activated coagulation in early prediction of severe AP; (2) we reviewed in detail the results of experimental studies and clinical trials targeting coagulation-inflammation interactions in severe AP. Among laboratory tests, d-dimer and angiopoietin-2 measurements seem the most useful in early prediction of severe AP. Although most clinical trials evaluating anticoagulants in treatment of severe AP did not show benefits, they also did not show significantly increased bleeding risk. Promising results of human trials were published for low molecular weight heparin treatment. Several anticoagulants that proved beneficial in animal experiments are thus worth testing in patients. PMID:28208708

In vitro reconstruction of hybrid vascular tissue. Hierarchic and oriented cell layers.

PubMed

Kanda, K; Matsuda, T; Oka, T

1993-01-01

Hybrid vascular tissue was hierarchically reconstructed in vitro. A hybrid medial layer composed of type I collagen gel, in which SMCs derived from a mongrel dog were embedded, was formed on the inner surface of a compliant porous polyurethane graft (internal diameter = 3 mm). Endothelial cells (ECs) from the same animal were seeded and cultured on the hybrid media to build an intimal layer. Subsequently, hierarchically structured grafts constructed in this manner were subjected to pulsatile flow (flow rate: 8.5 ml/min; frequency: 60 rpm; amplitude: 5% of graft outer diameter) of culture medium (Medium 199 supplemented with 20% fetal calf serum). After stress loading for as long as 10 days, tissues were morphologically investigated with a light microscope and a scanning electron microscope. Inner surfaces of the hybrid tissues were covered with EC monolayers that aligned along the direction of the flow (i.e., longitudinally). However, SMCs beneath the intima aligned in the circumferential direction. These cellular orientations resembled those in native muscular arteries. The pulsatile stress loaded hybrid tissue mimicked native muscular arteries with respect to hierarchic structure and cellular orientation. In vitro mechanical stress loading on a hybrid graft might provide a high degree of integrity in terms of tissue structure that promises high tolerance toward hydrodynamic stress and regulation of vasomotor tone upon implantation.

Actual therapeutic management of allergic and hyperreactive nasal disorders

PubMed Central

Rudack, Claudia

2004-01-01

Allergic rhinitis (AR) and hyperractive disorders of the upper airways, depending upon the type of releasing stimuli, are defined as nasal hyperreactivity, for example in the case of AR, or as non-specific nasal hyperreactivity and as idiopathic rhinitis (IR) (synonyms frequently used in the past: non-specific nasal hyperreactivity; vasomotor rhinitis) in the case of non-characterised stimuli. An early and professional therapy of allergic disorders of the upper airways is of immense importance as allergic rhinitis is detected in comorbidities such as asthma and rhino sinusitis. The therapeutic concept is influenced by new and further developments in pharmacological substance classes such as antihistamines and glucocorticosteroids. Specific immune therapy, the only causal therapy for AR, has been reviewed over the past few years in respect of the type and pattern of application. However, to date no firm recommendations on oral, sublingual and /or nasal immune therapy have yet been drawn up based on investigations of these modifications. Therapeutic management of IR is aimed at a symptom-oriented therapy of nasal hyperactivity as etiological factors relating to this form of rhinitis are not yet sufficiently known. Drug groups such as mast cell stabilizers, systemic and topic antihistamines, topic and systemic glucocorticosteroids, ipatroium bromide and alpha symphatomimetics belong to the spectrum of the therapeutics employed. PMID:22073046

The effects of personality traits on quality of life.

PubMed

Bal, Meltem Demirgöz; Sahin, Nevin Hotun

2011-12-01

The aim of this study was to investigate the impact of women's personality traits and some sociodemographic variables on quality of life (QoL). This cross-sectional and correlational study was conducted among 320 Turkish women aged between 45 and 64 years who attended the Menopausal Polyclinic. Data were collected from the Turkish version of the Cervantes Personality Scale and the Turkish version of the Menopause-Specific Quality of Life Questionnaire. The mean (SD) age of the participants was 51.8 (5.3) years. The average (SD) age since menopause was found to be 46 (3.3) years. The menopausal QoL was correlated with education status, income level, working status, exercise routine, chronic health problems, family's/friends' support, and negative life events. Logistic regression analyses showed that the QoL in vasomotor, psychological, and sexual domains were 6.1, 9.2, and 11.4 times, respectively, lower in neurotic women than in emotionally stable women. In addition, the QoL in sexual domains were 3.3 times lower in introverted women than in extraverted women. These findings indicate that higher levels of introversion and higher levels of neuroticism lead to lower QoL among postmenopausal women. The results of this study support the hypothesis that personality would play an important role in women's QoL during the transition period of menopause.

Functional Assessment of Problem Behavior: Dispelling Myths, Overcoming Implementation Obstacles, and Developing New Lore

PubMed Central

2012-01-01

Hundreds of studies have shown the efficacy of treatments for problem behavior based on an understanding of its function. Assertions regarding the legitimacy of different types of functional assessment vary substantially across published articles, and best practices regarding the functional assessment process are sometimes difficult to cull from the empirical literature or from published discussions of the behavioral assessment process. A number of myths regarding the functional assessment process, which appear to be pervasive within different behavior-analytic research and practice communities, will be reviewed in the context of an attempt to develop new lore regarding the functional assessment process. Frequently described obstacles to implementing a critical aspect of the functional assessment process, the functional analysis, will be reviewed in the context of solutions for overcoming them. Finally, the aspects of the functional assessment process that should be exported to others versus those features that should remain the sole technological property of behavior analysts will be discussed. PMID:23326630

Extreme challenges on cardiovascular control during gravity transitions

NASA Astrophysics Data System (ADS)

Verheyden, B.; Beckers, F.; Aubert, A. E.

Introduction. During parabolic flights transient periods of hypergravity and microgravity are created. These periods cause translocations of bodily fluids in the longitudinal axis of the body, leading to altered cardiac preload and afterload. These extreme orthostatic challenges provide a unique platform to study baroreflex-mediated responses of the cardiovascular autonomic control system. This might have important features for the development of a model of cardiovascular deconditioning that is observed in a variety of patient populations. Purpose. Until now, due to methodological restrictions, most studies have been concentrating on the analysis of cardiovascular variability in time domain. The purpose of this study is to evaluate heart rate variability (HRV) and blood pressure variability (BPV) simultaneously, using frequency domain analysis techniques (low frequency power (LF: 0.04-0.15 Hz); high frequency power (HF: 0.16-0.4 Hz)), providing additional information about cardiac and vasomotor sympathetic modulation during gravity transitions. Methods. 12 healthy non-medicated volunteers (age = 24 ± 2.5 yr) underwent continuous ECG and blood pressure (BP) recordings during the 32nd and 34th parabolic flight campaign organized by ESA. The subjects performed 15 parabolas in supine and 15 parabolas in standing position. 5 transient gravity phases were abstracted; phase 1 and 5: before and after the parabola (1G); phase 2 and 4: at the ascending and descending leg of the parabola (2G); phase 3: at the apex of the parabola (0g). Phase 2, 3 and 4 last 20 seconds. Results. No significant differences were found in HRV and BPV parameters in supine position between the different gravity phases. In standing position, mean RR- interval was higher during 0G (900 ± 103 ms) compared to 1G (700 ± 87 ms) and 2G (600 ± 94 ms). Mean arterial BP remained relatively constant during 0G but tended to decrease during 2G (102 ± 2 mmHg vs. 105 ± 3 mmHg). Positive correlations were found between the evolution of pulse pressure (PP) and HR during the parabolic trajectory (r = 0.7). LF power and HF power of HRV evaluated in the opposite direction, but to the same extent, as shown by an increase (decrease) in HF (LF) power during 0G by ± 18% and a decrease (increase) in HF (LF) power during 2G by ± 33%, compared to 1G. In spite of a decrease in mean diastolic blood pressure (DBP) of about 10%, LF power of BPV increased by approximately 45% during 0G. The LF/HF ratio of the HRV spectrum decreased during 0G (± 45%) and increased during 2G (± 15%). Conclusion: Cardiac vagal reflex activity at initial microgravity is characterized by an increase in vagal modulation and a decrease in sympathetic modulation and is suggested to depend in the first place on increased PP and thus SV through high-pressure (arterial) receptors. In hypergravity the reverse phenomena occurs (increased sympathetic and decreased vagal activity. Increased vasomotor sympathetic modulation at early microgravity is suggested to depend on decreased DBP through the activation of low-pressure (cardiopulmonary) receptors.

The assessment of function. Part II: clinical perspective of a javelin thrower with low back and groin pain

PubMed Central

Reiman, Michael P; Manske, Robert C

2012-01-01

Assessment of an individual’s functional ability can be complex. This assessment should also be individualized and adaptable to changes in functional status. In the first article of this series, we operationally defined function, discussed the construct of function, examined the evidence as it relates to assessment methods of various aspects of function, and explored the multi-dimensional nature of the concept of function. In this case report, we aim to demonstrate the utilization of a multi-dimensional assessment method (functional performance testing) as it relates to a high-level athlete presenting with pain in the low back and groin. It is our intent to demonstrate how the clinician should continually adapt their assessment dependent on the current functional abilities of the patients. PMID:23633887

42 CFR 441.535 - Assessment of functional need.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Assessment of functional need. 441.535 Section 441...) § 441.535 Assessment of functional need. States must conduct a face-to-face assessment of the individual..., if applicable, service budget. (c) The assessment of functional need must be conducted at least every...

42 CFR 441.535 - Assessment of functional need.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Assessment of functional need. 441.535 Section 441...) § 441.535 Assessment of functional need. States must conduct a face-to-face assessment of the individual..., if applicable, service budget. (c) The assessment of functional need must be conducted at least every...

42 CFR 441.535 - Assessment of functional need.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Assessment of functional need. 441.535 Section 441...) § 441.535 Assessment of functional need. States must conduct a face-to-face assessment of the individual..., if applicable, service budget. (c) The assessment of functional need must be conducted at least every...