Publications by authors named "Nandu Goswami"

121 Publications

Analysis of retinal blood vessel diameters in patients with COPD undergoing a pulmonary rehabilitation program.

Microvasc Res 2021 Sep 4;139:104238. Epub 2021 Sep 4.

Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium; Department of Biology, University of Antwerp, Wilrijk, Belgium; Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium.

Background: Regular exercise positively affects cardiovascular physiology, translating into the adequate capacity of microvascular blood vessels to dilate in response to acute bouts of exercise. However, this remains unstudied in patients with chronic obstructive pulmonary disease (COPD), who often suffer from cardiovascular comorbidity. Therefore, we studied acute changes in retinal blood vessel diameters in response to high-intensity exercise in patients with COPD. The effect of an exercise-based 8-week pulmonary rehabilitation (PR) program was evaluated. We consider changes in these retinal metrics as an indicator of microvascular reactivity.

Methods: Demographics and clinical characteristics of 41 patients were collected at the start and end of the PR program. Patients performed a high-intensity exercise test on a cycle ergometer at the start and end of the PR program, during which we collected retinal images. Fundus images were taken immediately before and 0, 5, 10, 15, and 30 min after the ergometer test. Widths of retinal blood vessels, represented as Central Retinal Arteriolar and Venular Equivalents (CRAE and CRVE), were calculated.

Results: Thirty patients with COPD completed the study protocol (57% males; mean age: 64 ± 7 years; mean FEV: 45 ± 17%pred). We did not observe a change in retinal vessel widths following the ergometer test at the start of the PR program. This null result remained at the end of the 8-week PR program. Our observations did not alter when considering responders and non-responders to PR.

Conclusion: Retinal blood vessel diameters of patients with COPD did not change following an exercise test on an ergometer. The exercise-based PR program of eight weeks did not counteract the blunted retinal microvascular response.
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http://dx.doi.org/10.1016/j.mvr.2021.104238DOI Listing
September 2021

Comparison of endothelial function and cardiometabolic profiles of people living with HIV in two South African regions: the EndoAfrica study.

Cardiovasc J Afr 2021 Aug 11;32:1-6. Epub 2021 Aug 11.

Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa. Email:

Background: People living with HIV (PLWH) are at risk for cardiovascular disease, but regional differences have not been studied in South Africa. We compared endothelial function and cardiometabolic markers in PLWH and HIV-free controls from two distinct South African regions.

Methods: We measured flow-mediated dilation (FMD), cardiometabolic, immunological and viral markers in age- and gender-matched PLWH on antiretroviral therapy ( = 100/group) and HIV-free participants ( = 50/group) in samples from cohort studies in the North West and Western Cape provinces.

Results: Endothelial function and cardiometabolic profiles were not worse in PLWH than in HIV-free individuals, and %FMD was not associated with cardiometabolic, viral or immunological markers. PLWH from the North West region had lower %FMD but overall better metabolic profiles.

Conclusions: Ethnic, cultural and socio-economic differences need further investigation to understand the possible protective role of antiretroviral treatment on the vasculature and to direct region-specific HIV and AIDS guidelines in South Africa.
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http://dx.doi.org/10.5830/CVJA-2021-026DOI Listing
August 2021

Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy.

Biology (Basel) 2021 Jul 10;10(7). Epub 2021 Jul 10.

Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 8010 Graz, Austria.

Background: Lymphedema arises due to a malfunction of the lymphatic system, leading to extensive tissue swelling. Complete decongestive therapy (CDT), which is a physical therapy lasting for 3 weeks and includes manual lymphatic drainages (MLD), leads to fluid mobilization and increases in plasma volume. Here, we investigated hemodynamic responses induced by these fluid shifts due to CDT and MLD.

Methods: Hemodynamic parameters were assessed continuously during a sit-to-stand test (5 min baseline, 5 min of standing, and 5 min of recovery). This intervention was repeated on days 1, 2, 7, 14, and 21 of CDT, before and after MLD. Volume regulatory hormones were assessed in plasma samples.

Results: A total number of 13 patients took part in this investigation. Resting diastolic blood pressure significantly decreased over three weeks of CDT ( = 0.048). No changes in baseline values were shown due to MLD. However, MLD led to a significant decrease in heart rate during orthostatic loading over all epochs on therapy day 14, as well as day 21. Volume regulatory hormones did not show changes over lymphedema therapy.

Conclusion: We did not observe any signs of orthostatic hypotension at rest, as well as during to CDT, indicating that lymphedema patients do not display an elevated risk of orthostatic intolerance. Although baseline hemodynamics were not affected, MLD has shown to have potential beneficial effects on hemodynamic responses to a sit-to-stand test in patients undergoing lymphedema therapy.
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http://dx.doi.org/10.3390/biology10070642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301048PMC
July 2021

COVID-19 and its effects on endothelium in HIV-positive patients in sub-Saharan Africa: Cardiometabolic risk, thrombosis and vascular function (ENDOCOVID STUDY).

BMC Infect Dis 2021 Jul 31;21(1):719. Epub 2021 Jul 31.

Department of Biological & Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University (WSU), Mthatha, South Africa.

Background: COVID-19 has affected almost every country in the world, especially in terms of health system capacity and economic burden. People from sub-Saharan Africa (SSA) often face interaction between human immunodeficiency virus (HIV) infection and non-communicable diseases such as cardiovascular disease. Role of HIV infection and anti-retroviral treatment (ART) in altered cardiovascular risk is questionable and there is still need to further carry out research in this field. However, thus far it is unclear, what impact the COVID-19 co-infection in people living with HIV (PLHIV), with or without therapy will have. The ENDOCOVID project aims to investigate whether and how HIV-infection in COVID-19 patients modulates the time course of the disease, alters cardiovascular risk, and changes vascular endothelial function and coagulation parameters/ thrombosis risk.

Methods: A total of 1026 patients will be included into this study. Cardiovascular research PLHIV with (n = 114 in each of the three recruiting centers) - or without - ART (n = 114 in each of the three recruiting centers) with COVID-19 and HIV-negative with COVID-19 (n = 114 in each of the three recruiting centers) will be carried out via clinical and biochemical measurements for cardiovascular risk factors and biomarkers of cardiovascular disease (CVD). Vascular and endothelial function will be measured by brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) assessments, and retinal blood vessel analyses, along with vascular endothelial biomarkers and cogualation markers. The correlation between HIV-infection in COVID-19 PLHIV with or without ART and its role in enhancement of cardiovascular risk and endothelial dysfunction will be assessed at admission, weekly, at discharge and, 4 weeks post-discharge (if possible).

Impact Of Project: The ENDOCOVID project aims to evaluate in the long-term the cardiovascular risk and vascular endothelial function in PLHIV thus revealing an important transitional cardiovascular phenotype in COVID-19. The study was registered under clinicaltrials.gov (NCT04709302).
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http://dx.doi.org/10.1186/s12879-021-06426-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325201PMC
July 2021

Impact of a Single 36 Hours Prolonged Fasting Period in Adults With Type 1 Diabetes - A Cross-Over Controlled Trial.

Front Endocrinol (Lausanne) 2021 6;12:656346. Epub 2021 Jul 6.

Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Prolonged fasting has shown beneficial effects in healthy individuals and in people with chronic diseases. In type 1 diabetes, the effect or even the feasibility of fasting is unclear. We aimed to assess the impact and safety of prolonged fasting in adults with type 1 diabetes. Glycemia was assessed during overnight fasting (12 hours) vs. prolonged fasting (36 hours) an intermittently-scanned continuous glucose monitoring system. Anthropometric data, metabolic and hormonal markers were compared between both trial arms. After each fasting period, a 75 g oral glucose tolerance test was performed and plasma glucose levels and hormones were assessed. Data were compared paired t-tests and mixed-model regressions (p ≤ 0.05). Twenty individuals with type 1 diabetes (7 females) with a mean ± SD age of 35 ± 11 years, body mass index (BMI) 24.8 ± 2.8 kg/m and HbA 54 ± 7 mmol/mol were included. Hypoglycemia/hour (70 mg/dL; <3.9 mmol/L) was similar in both trial arms (12 hrs: 0.07 ± 0.06 36 hrs: 0.05 ± 0.03, p=0.21). Glycemic excursions during the oral glucose tolerance test were not different after the two fasting periods. Beta-hydroxybutyrate levels were higher after prolonged fasting (p=0.0006). Our study showed that people with type 1 diabetes can safely perform a 36 hours fasting period with a low risk of hypoglycemia and ketoacidosis.

Clinical Trial Registration: DRKS.de, identifier DRKS00016148.
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http://dx.doi.org/10.3389/fendo.2021.656346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292020PMC
July 2021

A Randomized Crossover Trial on the Acute Cardiovascular Demands During Flywheel Exercise.

Front Physiol 2021 25;12:665462. Epub 2021 Jun 25.

Science and Research Center Koper, Institute for Kinesiology Research, Koper, Slovenia.

In a randomized crossover trial, we examined whether age plays a role in the mean arterial pressure (MAP) response during a vigorous flywheel exercise of varying load. We hypothesized that the magnitude of increase in the MAP during the flywheel exercise would increase in proportion to advancing age, thereby imposing a significant challenge to the cardiovascular system. A total of 30 participants of both sexes (age range from 20-55 y, 37% women) underwent a detailed medical examination, and their maximal oxygen uptake was determined. They performed a squat exercise (2 sets × 7 repetitions) on a flywheel ergometer at three randomly assigned moments of inertia set at 0.025, 0.05, and 0.075 kg m, while the cardiovascular response was continuously recorded via a Task force monitor. Compared to the resting values, robust rises in the MAP were observed during all three flywheel loads, reaching the highest value of 179 ± 4 mmHg ( = 0.001) during the highest load. In parallel, the cardiac index (cardiac output normalized by the body surface area) was two-fold greater during all the flywheel loads compared to rest, and at a high load, exclusively, the total peripheral resistance increased by 11% ( = 0.001). The rise in heart rate compensated for a load-dependent drop in the stroke index (stroke volume normalized by the body surface area). In our study population, no correlations were observed between the relative increase in the MAP and the participants' age for the three flywheel loads. The present findings suggest that the larger moments of inertia impose a substantial burden to the cardiovascular system, without apparent associated age-differences of the relative magnitude of MAP rise throughout the exercise.
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http://dx.doi.org/10.3389/fphys.2021.665462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267577PMC
June 2021

Assessment of the impact of HIV infection and anti-retroviral treatment on the cardiometabolic health of pregnant mothers and their offspring (ARTMOMSBABES).

BMC Cardiovasc Disord 2021 06 30;21(1):322. Epub 2021 Jun 30.

Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, 8036, Graz, Austria.

Background: The risk of cardiovascular diseases (CVDs) is becoming more prevalent in pregnant women though not much data is available for pregnant women with human immunodeficiency virus (HIV). Foetoplacental vascular endothelial dysfunction is thought to be at the origin of chronic diseases such as diabetes and obesity later on in life. Because HIV and anti-retroviral treatment (ARTs) are associated with endothelial dysfunction, children exposed in utero to these conditions may be at greater risk of developing CVDs. Despite the high prevalence of HIV in pregnant South African women, little is known about the effects of ART on the cardiovascular health of the mother and offspring. Hence, the proposed study intends to investigate how HIV/ARTs may affect the cardiovascular health of the mother and offspring at different time points during the pregnancy and up to 2 years after birth.

Methods: A longitudinal case-control study in HIV positive pregnant women on ART and HIV negative pregnant women will be conducted. All pregnant women will be assessed for cardio-metabolic risk factors and markers (lipids, anthropometric and glycaemic indies, oxidative stress), hemodynamic status (blood pressure parameters) and vascular function (arterial compliance, retinal microvasculature, uterine artery mean pulsatility index). Child health will be monitored in utero and postnatally via routine foetal health screening, placental integrity, anthropometry, blood pressure parameters, markers of oxidative stress and endothelial function in cord blood and cardiovascular epigenetic markers in urine.

Discussion: There is a paucity of studies in South Africa and sub-Sahara Africa as a whole that utilised a longitudinal study model to assess the effects of ARTs on vascular endothelial changes in pregnant women living with HIV and the cardiometabolic health of their offspring. This study will therefore help to monitor changes in cardiometabolic risk during pregnancy and in children exposed in utero to HIV-infection and ART use. Findings from this study will provide useful information for developing guidelines on the use of ARTs in pregnancy and management of cardiometabolic health of the offspring of HIV positive mothers.
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http://dx.doi.org/10.1186/s12872-021-02130-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247111PMC
June 2021

Developing a "dry lab" activity using lower body negative pressure to teach physiology.

Adv Physiol Educ 2021 Sep;45(3):445-453

Department of Physiology, Autonomic Function Laboratory, All India Institute of Medical Sciences, New Delhi, India.

In this paper we assessed how lower body negative pressure (LBNP) can be used to teach students the physiological effects of central hypovolemia in the absence of the LBNP and/or a medical monitor using a "dry lab" activity using LBNP data that have been previously collected. This activity was performed using published LBNP papers, with which students could explore LBNP as an important tool to study physiological responses to central hypovolemia as well as consider issues in performing an LBNP experiment and interpreting experimental results. The activity was performed at the All India Institute of Medical Sciences, New Delhi, with 31 graduate students and 4 teachers of physiology. Both students and teachers were provided with a set of questionnaires that inquired about aspects related to the structure of the activity and how this activity integrated research and knowledge, as well as aspects related to motivation of the students and teachers to perform the activity. Our results from student and teacher surveys suggest that a "dry lab" activity using LBNP to teach physiology can be an important tool to expose students to the basics of systems physiology as well as to provide useful insights into how research is performed. Providing insight into research includes formulating a research question and then designing (including taking into account confounding variables), implementing, conducting, and interpreting research studies. Finally, developing such an activity using LBNP can also serve as a basis for developing research capacities and interests of students even early in their medical studies.
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http://dx.doi.org/10.1152/advan.00123.2020DOI Listing
September 2021

Independent influence of age on heart rate recovery after flywheel exercise in trained men and women.

Sci Rep 2021 Jun 8;11(1):12011. Epub 2021 Jun 8.

Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia.

The present study examined whether differences in the heart rate recovery following flywheel exercise cessation were associated with differences in maximal oxygen uptake ([Formula: see text]O max.), age and sex in trained adults. Eleven men (age range 22-49 years, [Formula: see text]O max. = 43.6 ± 7.6 mL kg min) and ten women (age range 20-53 years, [Formula: see text]O max. = 38.0 ± 5.7 mL kg min) were randomly assigned to complete a squat-exercise on the flywheel ergometer set at three different moments of inertia, while their cardiovascular responses were continuously monitored. During the flywheel exercise the mean arterial pressure rose by ~ 35 to 40% (p = .001), and the increment was more robust in men than women. The cardiac index was two-fold greater across both sexes compared to the baseline (p = .001), while the rise in heart rate (~ 144 bpm) was more pronounced in women to compensate for their load-dependent stroke index decline (p = .001). The load-independent time-course changes in heart rate recovery markers were comparable between the sexes. When these indicators were pooled, a stepwise regression revealed age as the only relevant predictor of both fast and slow components of the heart rate recovery (~ 30% of the shared variance explained, p = .014). The present data suggest that the heart rate recovery declines with age, irrespective of sex, or well-preserved cardiorespiratory fitness in moderately-trained adults.
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http://dx.doi.org/10.1038/s41598-021-91565-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187710PMC
June 2021

Subcutaneous Adipose Tissue Measured by B-Mode Ultrasound to Assess and Monitor Obesity and Cardio-Metabolic Risk in Children and Adolescents.

Biology (Basel) 2021 May 20;10(5). Epub 2021 May 20.

Otto Loewi Research Center for Vascular Biology, Physiology Division, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria.

Monitoring of children at heightened risk of cardio-metabolic diseases raises the need for accurate assessment of obesity. A standardized approach for measuring subcutaneous adipose tissue (SAT) by bright-mode ultrasound was evaluated in relation to body indices and anthropometry in a cross-sectional sample of 76 South African children (7-10 years) and 86 adolescents (13-17 years) to assess cardio-metabolic risk. SAT was higher in girls as compared to boys (children: 50.0 ± 21.7 mm > 34.42 ± 15.8 mm, adolescents: 140.9 ± 59.4 mm > 79.5 ± 75.6 mm, < 0.001) and up to four times higher in adolescents than in children. In children, measures of relative body weight showed only a poor correlation to SAT (BMI: r = 0.607, < 0.001), while in adolescents, BMI correlated high with SAT (r = 0.906, < 0.001) based on high rates of overweight and obesity (41.8%). Children with identical BMIs may have large differences (>2-3-fold) in their amount of SAT. The moderate association to systolic (r = 0.534, r = 0.550, < 0.001) and diastolic blood pressure (r = 0.402, r = 0.262, < 0.001) further substantiates that SAT measured by ultrasound provides an accurate, safe and easy applicable approach for monitoring in children and adolescents at cardio-metabolic risk.
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http://dx.doi.org/10.3390/biology10050449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161059PMC
May 2021

Correlation between timed up and go test and skeletal muscle tensiomyography in female nursing home residents.

J Musculoskelet Neuronal Interact 2021 06;21(2):247-254

Alma Mater Europaea ECM, Maribor, Slovenia.

Objectives: Tensiomyography (TMG) derived contraction time (Tc) and amplitude (Dm) are related to muscle fibre composition and to muscle atrophy/tone, respectively. However, the link between mobility and TMG-derived skeletal muscle contractile properties in older persons is unknown. The aim of the study was to correlate lower limb skeletal muscle contractile properties with balance and mobility measures in senior female residents of retirement homes in Austria.

Methods: Twenty-eight female participants (aged from 67-99 years) were included in measurements of contractile properties (TMG) of four skeletal muscles: vastus lateralis, vastus medialis, biceps femoris and gastrocnemius medialis. Their balance and mobility performance was measured using a timed up and go test (TUG).

Results: Time needed to complete TUG is negatively correlated to biceps femoris (r= -0.490; p= 0.008), vastus lateralis (r= -0.414; p=0.028) and vastus medialis (r= -0.353; p=0.066) Dm and positively correlated to vastus lateralis Tc (r=0.456; p=0.015). Overall, vastus lateralis Tc and vastus medialis Dm explained 37% of TUG time variance.

Conclusions: Our study demonstrates that TMG-derived quadriceps muscle contractile parameters are correlated with the balance and mobility function in female nursing home residents.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185258PMC
June 2021

The effect of physical activity intervention and nutritional habits on anthropometric measures in elementary school children: the health oriented pedagogical project (HOPP).

Int J Obes (Lond) 2021 08 10;45(8):1677-1686. Epub 2021 May 10.

School of Health Sciences, Kristiania University College, Oslo, Norway.

Background: Overweight and obesity are a burden of the modern world that requires urgent action. Prevention has proven to be efficient in the fight against overweight and obesity. As many children gain excessive weight at an early age, intervention during school years are important. While daily physical activity (PA) is known to have an influence on overweight and obesity prevention, the importance of a healthy lifestyle, including dietary habits, should not be underestimated. The aim of this study was to assess how a combination of daily PA and healthy/unhealthy diet affect the anthropometric measures of 4th graders in Norway.

Methods: The Health Oriented Pedagogical Project (HOPP) is a longitudinal intervention in primary school children, which includes increased amount of daily physical activity during teaching- active learning. Assessed were weight, muscle and bone mass, as well as fat mass, using a bio-impedance Tanita scale. A dietary survey, Ungkost 2000, with 18 multiple-choice questions was used to evaluate the overall nutrition characteristics of the children.

Results: Between 2015 and 2018, a total of 917 (intervention group n = 614, control group n = 303) 4th graders from nine different schools from the south-east part of Norway participated. We observed that daily PA and a regular healthy diet increases-while an unhealthy diet decreases-muscle and bone mass despite daily PA. Daily PA appears to counteract some of the effects of an unhealthy diet on weight and fat mass. In addition, daily PA and a regular intake of fruits and berries lowers weight and fat mass in children with overweight.

Conclusion: Combination of daily 45-minute of PA and a healthy diet leads to reductions in body weight and incease in muscle and bone mass in elementary school children.
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http://dx.doi.org/10.1038/s41366-021-00830-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8310789PMC
August 2021

EndoBarrier™ Implantation Rapidly Improves Insulin Sensitivity in Obese Individuals with Type 2 Diabetes Mellitus.

Biomolecules 2021 04 14;11(4). Epub 2021 Apr 14.

Division of Endocrinology and Diabetology, Medical University of Graz, 8010 Graz, Austria.

The EndoBarrier™ medical device is a duodenal-jejunal bypass liner designed to mimic the effects of gastric bypass surgery to induce weight loss and glycaemic improvement. In this study, 10 participants with type 2 diabetes mellitus (T2DM), a mean body mass index (BMI) of 43.3 ± 5.0 (kg/m) and a mean glycated haemoglobin A1c (HbA1c) of 60.6 ± 8.6 mmol/mol were examined at baseline (before implantation of EndoBarrier™), 4 weeks after implantation, at 36 weeks (right before explantation) and 24 weeks after the removal of the device to explore the short and long-term effects on glucose metabolism. Besides a significant reduction in body weight and fat mass, EndoBarrier™ treatment significantly improved insulin sensitivity during Botnia clamp investigations after four weeks of implantation. The beneficial effects decreased over time but remained significant 24 weeks after removal of the device.
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http://dx.doi.org/10.3390/biom11040574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070956PMC
April 2021

A Perspective on COVID-19 Management.

J Clin Med 2021 Apr 9;10(8). Epub 2021 Apr 9.

Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstraße 6/D.05, 8010 Graz, Austria.

A novel coronavirus-Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2)-outbreak correlated with the global coronavirus disease 2019 (COVID-19) pandemic was declared by the WHO in March 2020, resulting in numerous counted cases attributed to SARS-CoV-2 worldwide. Herein, we discuss current knowledge on the available therapy options for patients diagnosed with COVID-19. Based on available scientific data, we present an overview of solutions in COVID-19 management by use of drugs, vaccines and antibodies. Many questions with non-conclusive answers on the measures for the management of the COVID-19 pandemic and its impact on health still exist-i.e., the actual infection percentage of the population, updated precise mortality data, variability in response to infection by the population, the nature of immunity and its duration, vaccine development issues, a fear that science might end up with excessive promises in response to COVID-19-and were raised among scientists. Indeed, science may or may not deliver results in real time. In the presented paper we discuss some consequences of disease, its detection and serological tests, some solutions to disease prevention and management, pitfalls and obstacles, including vaccination. The presented ideas and data herein are meant to contribute to the ongoing debate on COVID-19 without pre-selection of available information.
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http://dx.doi.org/10.3390/jcm10081586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070140PMC
April 2021

Lymphatic Senescence: Current Updates and Perspectives.

Biology (Basel) 2021 Apr 3;10(4). Epub 2021 Apr 3.

Physiology Division, Otto Loewi Research Center, Medical University of Graz, 8036 Graz, Austria.

Lymphatic flow is necessary for maintenance of vital physiological functions in humans and animals. To carry out optimal lymphatic flow, adequate contractile activity of the lymphatic collectors is necessary. Like in all body systems, aging has also an effect on the lymphatic system. However, limited knowledge is available on how aging directly affects the lymphatic system anatomy, physiology and function. We investigated how senescence leads to alterations in morphology and function of the lymphatic vessels. We used the strategy of a review to summarize the scientific literature of studies that have been published in the area of lymphatic senescence. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 1060 publications. They were filtered to 114 publications based on strict inclusion and exclusion criteria. Finally, the most appropriate 57 studies that specifically addressed lymphatic senescence have been selected for the preparation of this review. Analysis of the literature showed that lymphatic senescence is associated with alterations in lymphatic muscles and nerve fibers, lymphatic glycocalyx function of lymphatic endothelial cells, effects of chronic ultraviolet light exposure and oxidative stress as well as changes in lymphatic pump, acute inflammation responses and immune function. The current review underscores the relevance of the understudied area of lymphatic senescence. Continued research on the impact of aging on the structure and function of the lymphatic vasculature is needed to provide further insights to develop innovative clinical diagnostic-and treatment-modalities as well as to reduce the morbidity associated with diseases related to the lymphatic system.
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http://dx.doi.org/10.3390/biology10040293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066652PMC
April 2021

Biology of Lymphedema.

Biology (Basel) 2021 Mar 25;10(4). Epub 2021 Mar 25.

Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria.

This narrative review portrays the lymphatic system, a poorly understood but important physiological system. While several reviews have been published that are related to the biology of the lymphatic system and lymphedema, the physiological alternations, which arise due to disturbances of this system, and during lymphedema therapy, are poorly understood and, consequently, not widely reported. We present an inclusive collection of evidence from the scientific literature reflecting important developments in lymphedema research over the last few decades. This review aims at advancing the knowledge on the area of lymphatic system function as well as how system dysfunction, as seen in lymphedema, affects physiological systems and how lymphedema therapy modulates these mechanisms. We propose that future studies should aim at investigating, in-detail, aspects that are related to fluid regulation, hemodynamic responses, and endothelial and/or vascular changes due to lymphedema and lymphedema therapy.
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http://dx.doi.org/10.3390/biology10040261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065876PMC
March 2021

Effects of an Innovative Head-Up Tilt Protocol on Blood Pressure and Arterial Stiffness Changes.

J Clin Med 2021 Mar 13;10(6). Epub 2021 Mar 13.

Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, 3810 Graz, Austria.

The objective of our study was to identify blood pressure (BP) and pulse wave velocity (PWV) changes during orthostatic loading, using a new the head-up tilt test (HUTT), which incorporates the usage of a standardized hydrostatic column height.

Methods: 40 healthy subjects 20-32 years performed HUTT, which was standardized to a height of the hydrostatic column at 133 cm. Exposure time was 10 min in each of 3 positions: horizontal supine 1, HUTT, and horizontal supine 2. The individual tilt up angle made it possible to set the standard value of the hydrostatic column. Hemodynamic parameters were recorded beat to beat using "Task Force Monitor 3040 i", pulse-wave velocity (PWV) was measured with a sphygmograph-sphygmomanometer VaSera VS1500N.

Results: Orthostatic loading caused a significant increase in heart rate (HR) and a decrease in stroke volume (SV) ( < 0.05) but no significant reductions in cardiac output, changes in total vascular resistance (TVR), or BP. An analysis of personalized data on systolic blood pressure (SBP) changes in tilt up position as compared to horizontal position (ΔSBP) revealed non-significant changes in this index in 48% of subjects (orthostatic normotension group), in 32% there was a significant decrease in it (orthostatic hypotension group) and in 20% there was a significant increase in it (orthostatic hypertension group). These orthostatic changes were not accompanied by any clinical symptoms and/or syncope. During HUTT, all subjects had in the PWV a significant increase of approximately 27% ( < 0.001).

Conclusion: The new test protocol involving HUTT standardized to a height of hydrostatic column at 133 cm causes typical hemodynamics responses during orthostatic loading. Individual analysis of the subjects revealed subclinical orthostatic disorders (OSD) in up to 52% of the test persons. During HUTT, all test subjects showed a significant increase in PWV. The new innovative HUTT protocol can be applied in multi-center studies in healthy subjects to detect preclinical forms of orthostatic disorders under standard gravity load conditions.
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http://dx.doi.org/10.3390/jcm10061198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998828PMC
March 2021

Cardiometabolic risk factors and early indicators of vascular dysfunction: a cross-sectional cohort study in South African adolescents.

BMJ Open 2021 03 17;11(3):e042955. Epub 2021 Mar 17.

Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria

Objectives: Prevalence of child and adolescents' overweight and obesity in low- and middle-income countries has increased dramatically. Simultaneously, the incidence of pre-hypertension/hypertension is also increasing in children, which, in turn, predisposes these children to the risk of cardiovascular disease (CVD) in later life. The present study assessed cardiometabolic risk factors and early indicators of vascular dysfunction in adolescents from a low socio-economic rural area in South Africa.

Design: Cross-sectional cohort study.

Setting: The study was conducted in public schools in Mthatha, OR Tambo district municipality, Eastern Cape Province, South Africa.

Participants: A total of 244 adolescents (188 females) of African ancestry aged 13-16 years were enrolled.

Primary And Secondary Outcome Measures: Anthropometric and haemodynamic measures and pulse wave velocity (PWV) were related to overweight/obesity and hypertension. Blood markers of cardiometabolic syndrome were assessed as well as vascular function (via PWV).

Results: One-third (33.0%) of the adolescents exceeded the age and sex-specific body mass index percentiles for overweight (≥85th) or obesity (>95th) with a prevalence of 61.1% pre-hypertensives in this group. Overweight/obesity and hypertension were associated with higher triglycerides (lean:overweight: 0.79<1.01 mmol/L; normotensive:hypertensive: 0.82<0.89 mmol/L). Fasting glucose was higher in hypertensive as compared to normotensive adolescents (4.85>4.69 mmol/L, p<0.05). PWV was elevated in 25.9% of the children and significantly correlated with asymmetric dimethylarginine and systolic blood pressure (p<0.001).

Conclusion: Overweight/obesity and hypertension show a high prevalence in rural South African youth. Almost half of the studied adolescents are at risk for developing CVD. The high association between cardiometabolic risk factors and PWV further suggests that hypertension in adolescents may promote the progression of CVD in adulthood. Early detection of those at risk and the implementation of preventive strategies in underprivileged young people is urgently needed to stop the progression of vascular damage and manifestation of CVD in rural African children.
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http://dx.doi.org/10.1136/bmjopen-2020-042955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978086PMC
March 2021

Effects of physical therapy on hyaluronan clearance and volume regulating hormones in lower limb lymphedema patients: A pilot study.

Sci Prog 2021 Jan-Mar;104(1):36850421998485

Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.

Lymphedema is manifested as a chronic swelling arising due to stasis in the lymphatic flow. No cure is currently available. A non-invasive treatment is a 3 week complete decongestive therapy (CDT), including manual lymphatic drainage and compression bandaging to control swelling. As CDT leads to mobilization of several liters of fluid, effects of CDT on hyaluronan clearance (maker for lymphatic outflow), volume regulating hormones, total plasma protein as well as plasma density, osmolality and selected electrolytes were investigated. In this pilot study, we assessed hyaluronan and volume regulating hormone responses from plasma samples of nine patients (three males, six females, aged 55 ± 13 years) with lower limb lymphedema stage II-III, before - and after - CDT. A paired non-parametric test (Wilcoxon) was used to assess hormonal and plasma volume changes. Correlation was tested using Spearman's correlation. The main findings of this novel study are that lymphedema patients lost volume and weight after therapy. Hyaluronic acid did not significantly change pre- compared to post-CDT. Aldosterone increased significantly after therapy, while plasma renin activity increased, but not significantly. Plasma total protein, density, osmolality and sodium and chloride did not show differences after CDT. To our knowledge, no study has previously investigated the effects of CDT on volume regulating hormones or electrolytes. To identify the time-course of volume regulating hormones and lymphatic flow changes induced by CDT, future studies should assess these parameters serially over 3 weeks of therapy.
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http://dx.doi.org/10.1177/0036850421998485DOI Listing
March 2021

Cardiovascular effects of air pollution: current evidence from animal and human studies.

Am J Physiol Heart Circ Physiol 2021 04 29;320(4):H1417-H1439. Epub 2021 Jan 29.

Physiology Division, Otto Loewi Research Centre, Medical University of Graz, Graz, Austria.

Air pollution is a global health concern. Particulate matter (PM), a component of ambient air pollution, has been identified by the World Health Organization as one of the pollutants that poses the greatest threat to public health. Cardiovascular health effects have been extensively documented, and these effects are still being researched to provide an overview of recent literature regarding air pollution-associated cardiovascular morbidity and mortality in humans. Additionally, potential mechanisms through which air pollutants affect the cardiovascular system are discussed based on human and additional animal studies. We used the strategy of a narrative review to summarize the scientific literature of studies that were published in the past 7 yr. Searches were carried out on PubMed and Web of Science using predefined search queries. We obtained an initial set of 800 publications that were filtered to 78 publications that were relevant to include in this review. Analysis of the literature showed significant associations between air pollution, especially PM, and the risk of elevated blood pressure (BP), acute coronary syndrome, myocardial infarction (MI), cardiac arrhythmia, and heart failure (HF). Prominent mechanisms that underlie the adverse effects of air pollution include oxidative stress, systemic inflammation, endothelial dysfunction, autonomic imbalance, and thrombogenicity. The current review underscores the relevance of air pollution as a global health concern that affects cardiovascular health. More rigorous standards are needed to reduce the cardiovascular disease burden imposed by air pollution. Continued research on the health impact of air pollution is needed to provide further insight.
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http://dx.doi.org/10.1152/ajpheart.00706.2020DOI Listing
April 2021

Relationship between Endothelial Function, Antiretroviral Treatment and Cardiovascular Risk Factors in HIV Patients of African Descent in South Africa: A Cross-Sectional Study.

J Clin Med 2021 Jan 20;10(3). Epub 2021 Jan 20.

Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, 8000 Cape Town, South Africa.

Limited information on the effect of antiretroviral treatment (ART) on vascular function in South Africans of African descent living with human immunodeficiency virus (HIV) is available. The relationship between ART, vascular function and cardiovascular risk factors in South Africans of African ancestry with HIV was therefore studied. This cross-sectional study recruited 146 HIV-positive individuals on ART (HIVART), 163 HIV-positive individuals not on ART (HIVART) and 171 individuals without HIV (HIV) in Mthatha, Eastern Cape Province of South Africa. Flow-mediated dilation (FMD) test was performed to assess endothelial function. Anthropometry and blood pressure parameters were measured. Lipid profile, glycaemic indices, serum creatinine as well as CD4 count and viral load were assayed in blood. Urinary albumin to creatinine ratio (ACR) was determined as a marker of cardiovascular risk. Obesity and albuminuria were positively associated with HIV, and HIVART participants had significantly higher HDL cholesterol. Dyslipidaemia markers were significantly higher in hypertensive HIVART participants compared with the controls (HIVART and HIV participants). FMD was not different between HIVART participants and the controls. Moreover, HIVART participants with higher FMD showed lower total cholesterol and LDL cholesterol comparable to that of HIV and HIVART participants. A positive relationship between FMD and CD4 count was observed in HIVART participants. In conclusion, antiretroviral treatment was associated with cardiovascular risk factors, particularly dyslipidaemia, in hypertensive South Africans of African ancestry with HIV. Although, ART was not associated with endothelial dysfunction, flow-mediated dilatation was positively associated with CD4 count in HIV-positive participants on ART.
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http://dx.doi.org/10.3390/jcm10030392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864186PMC
January 2021

Cardiovascular Risk Factors and Their Relationship with Vascular Dysfunction in South African Children of African Ancestry.

J Clin Med 2021 Jan 19;10(2). Epub 2021 Jan 19.

Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Neue Stiftingtalstrasse 6, 8036 Graz, Austria.

Vascular dysfunction is known to be an initiator of the development and progression of cardiovascular diseases (CVDs). However, there is paucity of information on the relationship of vascular dysfunction with cardiovascular risk factors in children of African ancestry. This study investigated the relationship between cardiovascular risk factors and vascular function in South African children of African ancestry. A cross-sectional study on 6-9-year-old children in randomly selected rural and urban schools of the Eastern Cape Province of South Africa was conducted. General anthropometric indices were measured, followed by blood pressure (BP) measurements. The pulse wave velocity (PWV) was measured using a Vicorder. Albumin to creatinine ratio (ACR), asymmetric dimethylarginine (ADMA), 8-hydroxy-2deoxyguanosine (8-OHdG) and thiobarbituric acid reactive substance (TBARS) were assayed in urine. Children from urban settings (10.8%) had a higher prevalence of overweight/obesity than their rural counterparts (8.5%) while the prevalence of elevated/high blood pressure was higher in rural (23.2%) than urban children (19.0%). Mean arterial blood pressure (MAP) and diastolic blood pressure (DBP) increased with increasing PWV ( < 0.05). Body mass index (BMI), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) positively associated ( < 0.05) with PWV. Creatinine, albumin and ACR significantly ( < 0.005) increased with increasing ADMA. ADMA associated positively ( < 0.05) with creatinine and 8-OHdG. In conclusion, vascular dysfunction was associated with obesity, high blood pressure, oxidative stress and microalbuminuria in South African children of African ancestry.
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http://dx.doi.org/10.3390/jcm10020354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832309PMC
January 2021

Identification of novel diagnostic biomarkers in endometrial cancer using targeted metabolomic profiling.

Adv Med Sci 2021 Mar 24;66(1):46-51. Epub 2020 Dec 24.

Division of Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia.

Purpose: Endometrial cancer (EC) is the most common gynecological malignancy with high disease burden especially in advanced stages of the disease. Our study investigated the metabolomic profile of EC patient's serum with the aim of identifying novel diagnostic biomarkers that could be used especially in early disease detection.

Material And Methods: Using targeted metabolomic serum profiling based on HPLC-TQ/MS, women with EC (n ​= ​15) and controls (n ​= ​21) were examined for 232 endogenous metabolites.

Results: Top performing biomarkers included ceramides, acylcarnitines and 1-methyl adenosine. Top 4 biomarkers combined achieved 94% sensitivity with 75% specificity with AUC 92.5% (CI 90.5-94.5%). Individual markers also provided significant predictive values: C16-ceramide achieved sensitivity 73%, specificity 81%, AUC 0.83, C22-ceramide sensitivity 67%, specificity 81%, AUC 0.77, hydroxyhexadecenoylcarnitine sensitivity 60%, specificity 96%, AUC 0.76 and 1-methyladenosine sensitivity 67%, specificity 81%, AUC 0.75. The individual markers, however, did not reach the high sensitivity and specificity of the 4-biomarker combination.

Conclusions: Using mass spectrometry targeted metabolomic profiling, ceramides, acylcarnitines and 1-methyladenosine were identified as potential diagnostic biomarkers for EC. Additionally, these identified metabolites may provide additional insight into cancer cell metabolism.
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http://dx.doi.org/10.1016/j.advms.2020.12.001DOI Listing
March 2021

The prevalence of pediatric metabolic syndrome-a critical look on the discrepancies between definitions and its clinical importance.

Int J Obes (Lond) 2021 01 18;45(1):12-24. Epub 2020 Nov 18.

Physiology Division, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.

Introduction: The Metabolic Syndrome (MetS) describes the clustering of cardio-metabolic risk factors-including abdominal obesity, insulin resistance, elevated blood pressure, high levels of triglycerides, and low levels of high-density lipoproteins-that increase the risk for developing cardiovascular diseases and type 2 diabetes mellitus. However, a generally accepted definition of MetS in pediatric patients is still lacking.

Objectives: The aim was to summarize current prevalence data of childhood MetS as well as to discuss the continuing disagreement between different pediatric definitions and the clinical importance of such diagnosis.

Methodology: A systematic literature search on the prevalence of pediatric MetS was conducted. Articles that were published during the past 5 years (2014-2019), using at least one of four predetermined classifications (International Diabetes Federation, Cook et al., Ford et al., and de Ferranti et al.), were included.

Results: The search resulted in 1167 articles, of which 31 publications met all inclusion criteria.

Discussion: The prevalence of MetS ranged between 0.3 and 26.4%, whereby the rising number of children and adolescents with MetS partly depended on the definition used. The IDF definition generally provided the lowest prevalences (0.3-9.5%), whereas the classification of de Ferranti et al. yielded the highest (4.0-26.4%). In order to develop a more valid definition, further research on long-term consequences of childhood risk factors such as abdominal obesity, insulin resistance, hypertension, and dyslipidemia is needed. There is also a temptation to suggest one valid, globally accepted definition of metabolic syndrome for pediatric populations but we believe that it is more appropriate to suggest definitions of MetS that are specific to males vs. females, as well as being specific to race/ethnicity or geographic region. Finally, while this notion of definitions of MetS specific to certain subgroups is important, it still needs to be tested in future research.
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http://dx.doi.org/10.1038/s41366-020-00713-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752760PMC
January 2021

Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients.

J Clin Med 2020 Nov 16;9(11). Epub 2020 Nov 16.

Physiology Division, Otto Loewi Research Center, Gravitational Physiology and Medicine Research Unit, Medical University of Graz, 8036 Graz, Austria.

Complete decongestive therapy (CDT), a physical therapy including manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing limb volume in lymphedema patients. Details of fluid shifts occurring in response to CDT are currently not well studied. Therefore, we investigated fluid shifts before, during and after CDT. Thirteen patients (3 males and 10 females, aged 57 ± 8.0 years, 167.2 ± 8.3 cm height, 91.0 ± 23.4 kg weight) diagnosed with stage II leg lymphedema participated. Leg volume, limb and whole-body fluid composition (total body water (limbTBW/%TBW), extracellular (limbECF/%ECF) and intracellular (limbICF/%ICF fluid), as well as ECF/ICF and limbECF/limbICF ratios were determined using perometry and bioelectrical impedance spectroscopy. Plasma volume, proteins, osmolality, oncotic pressure and electrolytes were assessed. Leg volume ( < 0.001), limbECF ( = 0.041), limbICF ( = 0.005) and limbECF/limbICF decreased over CDT. Total leg volume and limbTBW were correlated (r = 0.635). %TBW ( = 0.001) and %ECF ( = 0.007) decreased over time. The maximum effects were seen within one week of CDT. LimbICF ( = 0.017), %TBW ( = 0.009) and %ICF ( = 0.003) increased post-MLD, whereas ECF/ICF decreased due to MLD. Plasma volume increased by 1.5% post-MLD, as well as albumin and the albumin-to-globulin ratio ( = 0.005 and = 0.049, respectively). Our results indicate that physical therapy leads to fluid shifts in lymphedema patients, with the greatest effects occurring within one week of therapy. Fluid shifts due to physical therapy were also reflected in increased plasma volume and plasma protein concentrations. Perometry, in contrast to bioelectrical impedance analysis, does not seem to be sensitive enough to detect small fluid changes caused by manual lymphatic drainage.
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http://dx.doi.org/10.3390/jcm9113678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697258PMC
November 2020

Falls Risk, Circadian Rhythms and Melatonin: Current Perspectives.

Clin Interv Aging 2020 11;15:2165-2174. Epub 2020 Nov 11.

Institute for Biomedical Research (BIOMED), Catholic University of Argentina (UCA) and National Scientific and Technical Research Council (CONICET), Autonomous City of Buenos Aires, Argentina.

Aging is associated with weakening of the circadian system. The circadian amplitude of most physiological variables is reduced, while the circadian phase becomes more labile and tends to occur earlier with advancing age. As the incidence of falls in older persons could follow circadian variations, a better understanding of conditions in which falls occur can lead to the implementation of countermeasures (such as adjusting the scheduling of hospital staff, or changing the timing of anti-hypertensive medication if falls are related to undesirable circadian patterns of blood pressure and/or heart rate). This includes knowing the times of the day, days of the week, and times of the year when falls are more likely to occur at home or in the hospital. Additionally, the links between aging processes and factors associated with an increased risk of developing autonomic dysfunction are well established. A strong association between heart rate variability indexes and aging has been shown. Circadian rhythms of autonomous nervous system activity may play important role for maintenance of orthostatic tolerance. Whether one is concerned with disease prediction and prevention or maintenance of healthy aging, the study of circadian rhythms and the broader time structure underlying physiopathology is helpful in terms of screening, early diagnosis and prognosis, as well as the timely institution of prophylactic and/or palliative/curative treatment. Timing the administration of such treatment as a function of circadian (and other) rhythms also could lead to reduction of falls in older persons. Finally, a prominent circadian rhythm characterizes melatonin, which peaks during the night. The circadian amplitude of melatonin decreases as a function of age, raising the questions whether such a decrease in the circadian amplitude of melatonin relates to a higher risk of falls and, if so, whether melatonin supplementation may be an effective countermeasure. This narrative review assesses the relationships between fall risk and the potential role circadian rhythms and melatonin play in mitigating this risk. We aim to provide healthcare workers adequate information about fall risk in older persons, including the potential role of the circadian rhythms and/or melatonin, as well as to lay foundations for future fall prevention interventional studies.
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http://dx.doi.org/10.2147/CIA.S283342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666981PMC
March 2021

Vascular health assessment with flow-mediated dilatation and retinal image analysis: a pilot study in an adult population from Cape Town.

Cardiovasc J Afr 2021 May-Jun 23;32(3):133-140. Epub 2020 Nov 13.

Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Stellenbosch University, Cape Town, South Africa.

Aim: Flow-mediated dilatation (FMD) and retinal vascular analysis (RVA) may assist in predicting cardiovascular disease (CVD) but are poorly characterised in South Africa. We recorded baseline FMD and retinal vascular widths in healthy participants, and investigated associations with cardiovascular risk factors.

Methods: Endothelial function (measured with FMD), microvascular structure (evaluated via fundus image analysis) and major CVD risk factors were assessed in 66 participants from Cape Town.

Results: Median FMD% was 9.6%, with higher values in females. Mean retinal arteriolar and venular widths were 156 and 250 µm, respectively. FMD was not associated with CVD risk factors. Hypertension was associated with narrower retinal arterioles and venules.

Conclusions: We report novel baseline FMD data in healthy South African adults from the Western Cape, and show that retinal microvascular calibres are associated with blood pressure. Our baseline FMD and RVA data could serve as a reference for future studies in South Africa.
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http://dx.doi.org/10.5830/CVJA-2020-046DOI Listing
November 2020

Coagulation Changes during Central Hypovolemia across Seasons.

J Clin Med 2020 Oct 27;9(11). Epub 2020 Oct 27.

Physiological Chemistry Division, Otto Loewi Research Center, Medical University of Graz, 8036 Graz, Austria.

Lower body negative pressure (LBNP) application simulates hemorrhage. We investigated how seasons affect coagulation values at rest and during LBNP. Healthy participants were tested in cold (November-April) and warm (May-October) months. Following a 30-min supine period, LBNP was started at -10 mmHg and increased by -10 mmHg every five minutes until a maximum of -40 mmHg. Recovery was for 10 min. Blood was collected at baseline, end of LBNP, and end of recovery. Hemostatic profiling included standard coagulation tests, calibrated automated thrombogram, thrombelastometry, impedance aggregometry, and thrombin formation markers. Seven men (25.0 ± 3.6 years, 79.7 ± 7.8 kg weight, 182.4 ± 3.3 cm height, and 23.8 ± 2.3 kg/m BMI) and six women (25.0 ± 2.4 years, 61.0 ± 8.4 kg weight, 167 ± 4.7 cm height, and 21.8 ± 2.4 kg/m BMI) participated. Baseline levels of prothrombin (FII), tissue factor (TF) and markers for thrombin generation F1+2 and the thrombin/antithrombin complex (TAT) were higher during summer. Factor VIII, prothrombin fragment 1+2 (F1+2), TAT and the coagulation time showed significant increases during LBNP in both seasons. Some calibrated automated thrombography variables (Calibrated automated thrombography (CAT): lag, time to peak (ttPeak), peak) shifted in a procoagulant direction during LBNP in summer. Red blood cell counts (RBC), hemoglobin and white blood cell counts (WBC) decreased during LBNP. LBNP application reduced prothrombin time in winter and activated partial thromboplastin time in summer. Greater levels of FII, TF, F1+2, and TAT-a more pronounced LBNP-induced procoagulative effect, especially in CAT parameters (lag time (LT), Peak, ttPeak, Velindex)-were seen in summer. These results could have substantial medical implications.
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http://dx.doi.org/10.3390/jcm9113461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692650PMC
October 2020

Quantitative falls risk assessment in elderly people: results from a clinical study with distance based timed up-and-go test recordings.

Physiol Meas 2020 12 17;41(11):115006. Epub 2020 Dec 17.

AIT Austrian Institute of Technology GmbH, Graz, Austria. Institute of Neural Engineering, Graz University of Technology, Graz, Austria.

Objective: A third of people over 65 years experiences at least one fall a year. The Timed Up-and-Go (TUG) test is commonly used to assess gait and balance and to evaluate an individual's risk of falling.

Approach: We conducted a clinical study with 46 older participants for evaluating the fall risk assessment capabilities of an ultra-sound based TUG test device. The fall protocols over a period of one year were used to classify participants as fallers and non-fallers. For frailty evaluation, state-of-the-art questionnaires were used. Fall recordings were compared to six TUG test measurements that were recorded in fallers and non-fallers.

Main Results: TUG test data were available for 39 participants (36 f, age 84.2 ± 8.2, BMI 26.0 ± 5.1). Twenty-three participants did fall at least once within the fall screening period. We fitted two different regression and probability models into a region of interest of the distance over time curve as derived from the TUG device. We found that the coefficient of determination for Gaussian bell-shaped curves (p < 0.05, AUC = 0.71) and linear regression lines (p < 0.02, AUC = 0.74) significantly separated fallers from non-fallers. Subtasks of the TUG test like the sit-up time showed near significance (p < 0.07, AUC = 0.67).

Significance: We found that specific features calculated from the TUG distance over time curve were significantly different between fallers and non-fallers in our study population. Automatic recording and analysis of TUG measurements could, therefore, reduce time of measurements and improve precision as compared to other methods currently being used in the assessments of fall risk.
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http://dx.doi.org/10.1088/1361-6579/abc352DOI Listing
December 2020
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