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Marcolini F, Arnone G, Weston C, Tempia Valenta S, Zini A, De Ronchi D, Atti AR. A case report about anorexia nervosa and ischemic stroke: what can we learn? J Eat Disord 2024; 12:111. [PMID: 39107833 PMCID: PMC11304811 DOI: 10.1186/s40337-024-01074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Anorexia Nervosa (AN) is a complex psychiatric illness, characterized by a high risk of developing cardiovascular complications. Given the high risk of vascular diseases in patients with AN, we can assume that patients with severe AN have a high risk of developing ischemic stroke. However, to the best of our knowledge, no reports of patients with AN presenting with ischemic stroke have been published, other than a report of the development of IS during refeeding therapy in patients with severe AN. CASE PRESENTATION The present case report is aimed at describing the characteristics of an ischemic stroke occurring in a 19-year-old university student who had a 6-month history of AN. She was a non-smoker, had no relevant medical history and no family history of stroke. Upon hospital admission due to symptoms of stroke (aphasia and facial droop), she exhibited severe malnutrition with a BMI of 12.8 kg/m2. Computerized tomography imaging revealed occlusion of the left M2 branch and a congruous extensive area of hypoperfusion. Further investigations ruled out all common causes of stroke: she had no vascular stenosis, no heart diseases or arrhythmias, and no shunts, and gave negative results in autoimmune, toxicological and thrombophilia screenings. CONCLUSION Clinicians should suspect development of severe complications, including ischemic stroke, in patients with severe AN. Further extensive group studies or group-based studies are needed to elucidate the etiology of ischemic stroke in patients with severe AN. This will enable us to develop more precise and effective interventions.
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Affiliation(s)
- F Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - G Arnone
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore, Bologna, Italy
| | - C Weston
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - S Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore, Bologna, Italy
| | - D De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - A R Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Porto AA, Benjamim CJR, da Silva Sobrinho AC, Gomes RL, Gonzaga LA, da Silva Rodrigues G, Vanderlei LCM, Garner DM, Valenti VE. Influence of Fluid Ingestion on Heart Rate, Cardiac Autonomic Modulation and Blood Pressure in Response to Physical Exercise: A Systematic Review with Meta-Analysis and Meta-Regression. Nutrients 2023; 15:4534. [PMID: 37960187 PMCID: PMC10650885 DOI: 10.3390/nu15214534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 11/15/2023] Open
Abstract
A systematic review was undertaken to investigate the involvement of hydration in heart rate (HR), HR variability (HRV) and diastolic (DBP) and systolic (SBP) blood pressure in response to exercise. Data synthesis: The EMBASE, MEDLINE, Cochrane Library, CINAHL, LILACS and Web of Science databases were searched. In total, 977 studies were recognized, but only 36 were included after final screening (33 studies in meta-analysis). This study includes randomized controlled trials (RCTs) and non-RCTs with subjects > 18 years old. The hydration group consumed water or isotonic drinks, while the control group did not ingest liquids. For the hydration protocol (before, during and after exercise), the HR values during the exercise were lower compared to the controls (-6.20 bpm, 95%CI: -8.69; -3.71). In the subgroup analysis, "water ingested before and during exercise" showed lower increases in HR during exercise (-6.20, 95%CI: 11.70 to -0.71), as did "water was ingested only during exercise" (-6.12, 95%CI: -9.35 to -2.89). Water intake during exercise only revealed a trend of avoiding greater increases in HR during exercise (-4,60, 95%CI: -9.41 to 0.22), although these values were not significantly different (p = 0.06) from those of the control. "Isotonic intake during exercise" showed lower HRs than the control (-7.23 bpm, 95% CI: -11.68 to -2.79). The HRV values following the exercise were higher in the hydration protocol (SMD = 0.48, 95%CI: 0.30 to 0.67). The values of the SBP were higher than those of the controls (2.25 mmHg, 95%CI: 0.08 to 4.42). Conclusions: Hydration-attenuated exercise-induced increases in HR during exercise, improved autonomic recovery via the acceleration of cardiac vagal modulation in response to exercise and caused a modest increase in SBP values, but did not exert effects on DBP following exercise.
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Affiliation(s)
- Andrey A. Porto
- Department of Movement Sciences, São Paulo State University, UNESP, Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (V.E.V.)
| | - Cicero Jonas R. Benjamim
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (C.J.R.B.); (A.C.d.S.S.); (G.d.S.R.)
| | - Andressa Crystine da Silva Sobrinho
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (C.J.R.B.); (A.C.d.S.S.); (G.d.S.R.)
| | - Rayana Loch Gomes
- Department of Nutrition, Faculty of Health Sciences, Federal University of Grande Dourados, Dourados 79804-970, MS, Brazil;
| | - Luana A. Gonzaga
- Department of Movement Sciences, São Paulo State University, UNESP, Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (V.E.V.)
| | - Guilherme da Silva Rodrigues
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (C.J.R.B.); (A.C.d.S.S.); (G.d.S.R.)
| | | | - David M. Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0BP, UK;
| | - Vitor E. Valenti
- Department of Movement Sciences, São Paulo State University, UNESP, Presidente Prudente 19060-900, SP, Brazil; (L.A.G.); (V.E.V.)
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França da Silva AK, Santos LA, Laurino MJL, Vanzella LM, Ribeiro F, Rozan GB, Vanderlei LCM. Hydration Influence on the Autonomic Recovery of the Coronary Diseases Patient: Geometric Indices Analysis. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2022; 93:230-239. [PMID: 32976086 DOI: 10.1080/02701367.2020.1818672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Purpose: To evaluate the recovery period of autonomic modulation, through geometric indices of heart rate variability (HRV), on coronary artery disease (CAD) patients submitted to a cardiovascular rehabilitation session (CR), associated with hydration. Methods: Thirty male participants of a CR program, diagnosed with CAD were submitted to the control (CP) and hydration protocol (HP) characterized by a CR session. Only during HP were the participants given 8 equal portions of water. The water amount was determined through the hydric loss measured at the CP. During the protocols, the heart rate was measured beat-by-beat at rest (5-10 minutes[M1]) and at recovery (0-5 minutes [M2], 5-10 minutes [M3], 15-20 minutes [M4], 25-30 minutes [M5], 40-45 minutes [M6], 55-60 minutes [M7]) for the HRV analysis, performed by the geometric indices: TINN, RRTRI, SD1, SD2 and SD1/SD2 ratio. Results: Statistically significant differences were observed between the protocols (SD1, pvalue = 0.022), moments (TINN, pvalue = 0.001; SD1, pvalue = 0.019; SD2, pvalue = 0.001; SD1/SD2, pvalue = 0.001) and moments vs. protocol interaction (SD1, pvalue = 0.019). The SD1 index pointed to acceleration of parasympathetic recovery in the first minutes after exercising (HP recovery after M3 [86.07 ± 32.31%] vs. CP recovery after M5[86.43 ± 24.56]) and increase in global variability (TINN-HP remained increased in longer, until M5 (M1 83.10 ± 55.76 ms to M5 116.82 ± 67.54 ms) vs. CP that remained increased for a short time, until M2 (M1 77.93 ± 68.56 ms to M2 134.82 ± 56.08 ms). Conclusions: In CAD patients, hydration promoted a more efficient recovery on parasympathetic autonomic modulation and increased the global HRV in the recovery period.
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Bryniarski P, Bryniarska M, Jezioro M, Andrysiak D, Filipczak-Bryniarska I. Prognostic factors, symptoms and consequences of dehydration and dyselectrolytemia in patients with terminal stomach cancer. Int J Palliat Nurs 2021; 27:46-52. [PMID: 33629907 DOI: 10.12968/ijpn.2021.27.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. AIMS To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. METHODS An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. FINDINGS Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. CONCLUSIONS Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.
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Affiliation(s)
| | | | - Maciej Jezioro
- Jagiellonian University Medical, College, Cracow, Poland
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Vasquez DN, Basualdo MN, Aphalo VM, Carreras LP, Plotnikow GA, Intile AD, Moreira J. Complications of Congenital Hernia in Pregnancy: A Case Report. A A Pract 2020; 13:102-106. [PMID: 30920425 DOI: 10.1213/xaa.0000000000001004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
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Affiliation(s)
- Daniela N Vasquez
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | | | - Vanina M Aphalo
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Lucía P Carreras
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Gustavo A Plotnikow
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Alfredo D Intile
- From the Intensive Care Unit, Sanatorio Anchorena, City of Buenos Aires, Argentina
| | - Joaquín Moreira
- Anesthesia, Sanatorio Anchorena, City of Buenos Aires, Argentina
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Akerman AP, Lucas SJE, Katare R, Cotter JD. Heat and Dehydration Additively Enhance Cardiovascular Outcomes following Orthostatically-Stressful Calisthenics Exercise. Front Physiol 2017; 8:756. [PMID: 29062280 PMCID: PMC5640974 DOI: 10.3389/fphys.2017.00756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/19/2017] [Indexed: 02/04/2023] Open
Abstract
Exercise and exogenous heat each stimulate multiple adaptations, but their roles are not well delineated, and that of the related stressor, dehydration, is largely unknown. While severe and prolonged hypohydration potentially “silences” the long-term heat acclimated phenotype, mild and transient dehydration may enhance cardiovascular and fluid-regulatory adaptations. We tested the hypothesis that exogenous heat stress and dehydration additively potentiate acute (24 h) cardiovascular and hematological outcomes following exercise. In a randomized crossover study, 10 physically-active volunteers (mean ± SD: 173 ± 11 cm; 72.1 ± 11.5 kg; 24 ± 3 year; 6 females) completed three trials of 90-min orthostatically-stressful calisthenics, in: (i) temperate conditions (22°C, 50% rh, no airflow; CON); (ii) heat (40°C, 60% rh) whilst euhydrated (HEAT), and (iii) heat with dehydration (no fluid ~16 h before and during exercise; HEAT+DEHY). Using linear mixed effects model analyses, core temperature (TCORE) rose 0.7°C more in HEAT than CON (95% CL: [0.5, 0.9]; p < 0.001), and another 0.4°C in HEAT+DEHY ([0.2, 0.5]; p < 0.001, vs. HEAT). Skin temperature also rose 1.2°C more in HEAT than CON ([0.6, 1.8]; p < 0.001), and similarly to HEAT+DEHY (p = 0.922 vs. HEAT). Peak heart rate was 40 b·min−1 higher in HEAT than in CON ([28, 51]; p < 0.001), and another 15 b·min−1 higher in HEAT+DEHY ([3, 27]; p = 0.011, vs. HEAT). Mean arterial pressure at 24-h recovery was not consistently below baseline after CON or HEAT (p ≥ 0.452), but was reduced 4 ± 1 mm Hg after HEAT+DEHY ([0, 8]; p = 0.020 vs. baseline). Plasma volume at 24 h after exercise increased in all trials; the 7% increase in HEAT was not reliably more than in CON (5%; p = 0.335), but was an additional 4% larger after HEAT+DEHY ([1, 8]; p = 0.005 vs. HEAT). Pooled-trial correlational analysis showed the rise in TCORE predicted the hypotension (r = −0.4) and plasma volume expansion (r = 0.6) at 24 h, with more hypotension reflecting more plasma expansion (r = −0.5). In conclusion, transient dehydration with heat potentiates short-term (24-h) hematological (hypervolemic) and cardiovascular (hypotensive) outcomes following calisthenics.
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Affiliation(s)
- Ashley P Akerman
- School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, New Zealand.,Department of Physiology, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Samuel J E Lucas
- Department of Physiology, Division of Health Sciences, University of Otago, Dunedin, New Zealand.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rajesh Katare
- Department of Physiology, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, New Zealand
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Moreno IL, Vanderlei LCM, Vanderlei FM, Pastre CM, Abreu LCD, Ferreira C. Effects of water ingestion throughout exercise and recovery on cardiac autonomic modulation during and after exercise. MOTRIZ: REVISTA DE EDUCACAO FISICA 2016. [DOI: 10.1590/s1980-6574201600030008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sontrop JM, Huang SH, Garg AX, Moist L, House AA, Gallo K, Clark WF. Effect of increased water intake on plasma copeptin in patients with chronic kidney disease: results from a pilot randomised controlled trial. BMJ Open 2015; 5:e008634. [PMID: 26603245 PMCID: PMC4663439 DOI: 10.1136/bmjopen-2015-008634] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Increased water intake may have a beneficial effect on the kidney through suppression of plasma vasopressin. We examined the effect of increased water intake on plasma copeptin (a marker of vasopressin) over 6 weeks in patients with chronic kidney disease. DESIGN Secondary analysis of a randomised controlled parallel-group pilot trial. SETTING Canada, 2012-2013. PARTICIPANTS 28 patients with stage 3 chronic kidney disease randomised (2:1) to a hydration (n=17) or control group (n=11). INTERVENTION The hydration group was coached to increase water intake by up to 1.5 L/day for 6 weeks. The control group was asked to maintain regular water intake. MEASURES AND OUTCOMES Participants provided blood and 24 h urine samples at baseline and 6 weeks. Change in plasma copeptin was compared within and between study groups. RESULTS Participants were 64% male with a mean age of 62 years and an estimated glomerular filtration rate of 40 mL/min/1.73 m(2). Between baseline and 6 weeks, 24 h urine volume increased by 0.7 L/day in the hydration group, rising from 2.3 to 3.0 L/day (p=0.01), while decreasing by 0.3 L/day among controls, from 2.0 to 1.7 L/day (p=0.07); between-group difference: 0.9 L/day (95% CI 0.37 to 1.46; p=0.002). In the hydration group, median copeptin decreased by 3.6 pmol/L, from 15.0 to 10.8 pmol/L (p=0.005), while remaining stable among controls at 19 pmol/L (p=0.76; p=0.19 for the between-group difference in median change); the between-group difference in mean change was 5.4 pmol/L (95% CI -1.2 to 12.0; p=0.11). CONCLUSIONS Adults with stage 3 chronic kidney disease can be successfully randomised to drink approximately 1 L more per day than controls. This increased water intake caused a significant decrease in plasma copeptin concentration. Our larger 12-month trial will examine whether increased water intake can slow renal decline in patients with chronic kidney disease. TRIAL REGISTRATION NUMBER NCT01753466.
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Affiliation(s)
- Jessica M Sontrop
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Shi-Han Huang
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Louise Moist
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Kerri Gallo
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - William F Clark
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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Kong X, Ma X, Yao J, Zheng S, Cui M, Xu D. Hypovolaemia was associated with clustering of major cardiovascular risk factors in general population. BMC Cardiovasc Disord 2014; 14:151. [PMID: 25361538 PMCID: PMC4223830 DOI: 10.1186/1471-2261-14-151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/21/2014] [Indexed: 12/20/2022] Open
Abstract
Background Previous studies indicated that the clustering of major cardiovascular disease (CVD) risk factors is common, and multiple unhealthy lifestyles are responsible for the clustering of CVD risk factors. However, little is known about the direct association between the volume load and the clustering of CVD risk factors in general population. Methods We investigated the association of the clustering of CVD risk factors (defined as two or more of the following factors: hypertension, diabetes, dyslipidemia and overweight) with volume load, which was evaluated by bioelectrical impedance analysis. Hypovolaemia was defined as extracellular water/total body water (ECW/TBW) at and under the 10th percentile for the normal population. Results Among the 7900 adults, only 29.3% were free of any pre-defined CVD risk factors and 40.8% had clustering of CVD risk factors. Hypovolaemia in clustering group was statistically higher than that either in the single or in the none risk factor group, which was 23.7% vs. 17.0% and 10.0%, respectively (P <0.001). As a categorical outcome, the percentage of the lowest quartiles of ECW/TBW and TBW/TBWwatson in clustering group were statistically higher than either those in the single or in the none risk factor group, which were 44.9% vs. 36.9% and 25.1% (P <0.001), 36.2% vs. 32.2% and 25.0%, respectively (P <0.001). After adjusting of potential confounders, hypovolaemia was significantly associated with clustering of CVD risk factors, with an OR of 1.66 (95% CI, 1.45-1.90). Conclusions Hypovolaemia was associated with clustering of major CVD risk factors, which further confirms the importance of lifestyle for the development of CVD.
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Affiliation(s)
| | | | | | | | | | - Dongmei Xu
- Department of Nephrology, Qianfoshan Hospital, Shandong University, No,16766, Jingshi Road, Jinan 250014, PR China.
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Moreno IL, Vanderlei LCM, Pastre CM, Vanderlei FM, de Abreu LC, Ferreira C. Cardiorespiratory effects of water ingestion during and after exercise. Int Arch Med 2013; 6:35. [PMID: 24059759 PMCID: PMC3849535 DOI: 10.1186/1755-7682-6-35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In prolonged exercise, the state of hypohydration due to sweating raises physiological stress and induces a drop in sports performance. However, the impact of water intake in cardiorespiratory parameters when administered during and after physical activity has not been well studied. This study aimed to analyze the effects of water intake in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), partial oxygen saturation (SpO2) and respiratory rate during and after prolonged exercise. METHODS Thirty-one young males (21.55 ± 1.89 yr) performed three different protocols (48 h interval between each stage): I) maximal exercise test to determine the load for the protocols; II) Control protocol (CP) and; III) Experimental protocol (EP). The protocols consisted of 10 min at rest with the subject in the supine position, 90 min of treadmill exercise (60% of VO2 peak) and 60 min of rest placed in the dorsal decubitus position. No rehydration beverage consumption was allowed during CP. During EP, however, the subjects were given water (Vittalev, Spaipa, Brazil). The parameters HR, SBP, DBP, SpO2 and respiratory rate were measured at the end of the rest, in 30, 60 and 90 minutes of the activity, except the respiratory rate parameter, and at 1, 3, 5, 7, 10, 20, 30, 40, 50 and 60 minute post- exercise. RESULTS The hydration protocol provided minimal changes in SBP and DBP and a smaller increase in HR and did not significantly affect SpO2 during exercise and better HR recovery, faster return of SBP and DBP and a better performance for SpO2 and respiratory rate post-exercise. CONCLUSION Hydration with water influenced the behavior of cardiorespiratory parameters in healthy young subjects.
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Affiliation(s)
- Isadora Lessa Moreno
- Department of Medicine, Cardiology Division, UNIFESP - Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Carlos Marcelo Pastre
- Department of Physical Therapy, UNESP – State University Paulista, Presidente Prudente, SP, Brazil
| | - Franciele Marques Vanderlei
- Department of Medicine, Cardiology Division, UNIFESP - Federal University of São Paulo, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Laboratory of Scientific Writing, School of Medicine of ABC, Santo André, SP, Brazil
| | - Celso Ferreira
- Department of Medicine, Cardiology Division, UNIFESP - Federal University of São Paulo, São Paulo, SP, Brazil
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Vanderlei FM, Moreno IL, Vanderlei LCM, Pastre CM, de Abreu LC, Ferreira C. Effects of different protocols of hydration on cardiorespiratory parameters during exercise and recovery. Int Arch Med 2013; 6:33. [PMID: 23968198 PMCID: PMC3765387 DOI: 10.1186/1755-7682-6-33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/19/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Hydration plays a key role in the physiological maintenance required by exercise. OBJECTIVE To evaluate the behavior of heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, pulse oxygen saturation (SpO2) and respiratory rate (RR) of young people during and after prolonged physical exercise, with and without the intake of water or isotonic solution. METHOD 31 young individuals (21.63 ± 1.86 years) were subjected to a four-step protocol with a 48-hour interval between each step, namely: i) a test to determine the incremental load used in subsequent steps, ii) a control protocol without hydration (CP), iii) an experimental protocol with water intake (PE1), iv) an experimental protocol with ingestion of isotonic (PE2). The protocols consisted of 10 min rest, 90 min of exercise on a treadmill at 60% of VO2peak and 60 min of recovery. The parameters HR, SBP, DBP, RR and SPO2 were measured at rest, at 30, 60 and 90 min of exercise, with the exception of RR; and at 1, 3, 5, 7, 10, 20, 30, 40, 50 and 60 min of recovery. The two-factor analysis of variance for repeated measures model was used for analysis (p<0.05). RESULTS There was a moment effect for all variables in exercise (p<0.001), however, no effect was observed between the protocols (SBP, p=0.998; DBP, p=0.897; SpO2, p=0.077, HR=0.281) and in the interaction moment and protocol (SBP, p=0.058; DBP, p=0.191 and SpO2, p=0.510, HR=0.496). In recovery there was also a moment effect for all variables analyzed (p<0.001). There was no effect among protocols for SBP (p=0.986), DBP (p=0.536) and RR (p=0.539), however in the SpO2 (p=0.001) and HR (p=0.033) variables, effects were observed between the protocols. Regarding the moment and protocol interaction, an effect was observed for HR (SBP, p=0.431; DBP, p=0.086; SpO2, p=0.445, RR, p=0.147, HR, p=0.022). CONCLUSION For the type of exercise performed, both the water and the isotonic solution influenced the behavior of cardiorespiratory parameters, and independent of the type of hydration given the behavior of the parameters studied was similar.
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Affiliation(s)
- Franciele Marques Vanderlei
- Doctoral student in Medicine (Cardiology), Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil.
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Moreno IL, Pastre CM, Ferreira C, de Abreu LC, Valenti VE, Vanderlei LCM. Effects of an isotonic beverage on autonomic regulation during and after exercise. J Int Soc Sports Nutr 2013; 10:2. [PMID: 23286515 PMCID: PMC3565914 DOI: 10.1186/1550-2783-10-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 12/13/2012] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED BACKGROUND With prolonged physical activity, it is important to maintain adequate fluid balance. The impact of consuming isotonic drinks during and after exercise on the autonomic regulation of cardiac function is unclear. This study aimed to analyze the effects of consuming an isotonic drink on heart rate variability (HRV) during and after prolonged exercise. METHODS Thirty-one young males (21.55 ± 1.89 yr) performed three different protocols (48 h interval between each stage): I) maximal exercise test to determine the load for the protocols; II) Control protocol (CP) and; III). Experimental protocol (EP). The protocols consisted of 10 min at rest with the subject in the supine position, 90 min of treadmill exercise (60% of VO2 peak) and 60 min of rest placed in the dorsal decubitus position. No rehydration beverage consumption was allowed during CP. During EP, however, the subjects were given an isotonic solution (Gatorade, Brazil) containing carbohydrate (30 g), sodium (225 mg), chloride (210 mg) and potassium (60 mg) per 500 ml of the drink. For analysis of HRV data, time and frequency domain indices were investigated. HRV was recorded at rest (5-10 min), during exercise (25-30 min, 55-60 min and 85-90 min) and post-exercise (5-10 min, 15-20 min, 25-30 min, 40-45 min and 55-60 min). RESULTS Regardless of hydration, alterations in the SNS and PSNS were observed, revealing an increase in the former and a decrease in the latter. Hydrating with isotonic solution during recovery induced significant changes in cardiac autonomic modulation, promoting faster recovery of linear HRV indices. CONCLUSION Hydration with isotonic solution did not significantly influence HRV during exercise; however, after exercise it promoted faster recovery of linear indices.
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Affiliation(s)
- Isadora Lessa Moreno
- UNIFESP - Federal University of São Paulo, Department of Medicine, Cardiology Division, São Paulo, SP, Brazil
- UNESP – State University Paulista, Department of Physical Therapy. Presidente Prudente, Paulista, SP, Brazil
- Departamento de Medicina, Disciplina de Cardiologia, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 715 Térreo, 04039-032, São Paulo, SP, Brazil
| | - Carlos Marcelo Pastre
- UNESP – State University Paulista, Department of Physical Therapy. Presidente Prudente, Paulista, SP, Brazil
| | - Celso Ferreira
- UNIFESP - Federal University of São Paulo, Department of Medicine, Cardiology Division, São Paulo, SP, Brazil
| | - Luiz Carlos de Abreu
- Laboratory of Scientific Writing, School of Medicine of ABC, Santo André, SP, Brazil
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Moreno IL, Pastre CM, Papoti M, Vanderlei LCM. Efeitos da reposição hidroeletrolítica sobre parâmetros cardiorrespiratórios em exercício e recuperação. MOTRIZ: REVISTA DE EDUCACAO FISICA 2012. [DOI: 10.1590/s1980-65742012000100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: a necessidade de reposição ao máximo das perdas hídricas tornou-se estabelecida e difundida nos consensos internacionais. Entretanto, permanece pouco compreendida a influência da reposição quando administrada, igualmente, durante e após o exercício sobre parâmetros cardiorrespiratórios. OBJETIVO: analisar os efeitos da reposição hidroeletrolítica na frequência cardíaca (FC), pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), saturação parcial de oxigênio (SpO2) e frequência respiratória (f) de jovens durante e após um exercício de longa duração. MÉTODOS: 31 jovens (21,55 ± 1,89 anos) realizaram três visitas ao laboratório (intervalo de 48 horas entre elas), sendo na primeira aplicado um teste incremental, para determinação da carga utilizada nas visitas seguintes, e nas duas últimas, denominadas protocolo controle (PC) e protocolo experimental (PE), os sujeitos foram submetidos a 10 min de repouso supino, 90 min de exercício em esteira ergométrica (60% do VO2pico) e 60 min de repouso supino. No PC não houve hidratação e no PE houve ingestão de solução isotônica. Os parâmetros FC, PAS, PAD, SpO2 e f foram mensurados no final do repouso; nos minutos 30, 60 e 90 do exercício, com exceção da f; e nos minutos 1, 3, 5, 7, 10, 20, 30, 40, 50 e 60 pós-exercício. Foi aplicado o teste t de Student ou teste de Mann-Whitney e ANOVA para medidas repetidas ou teste de Friedman seguidos de testes post hoc, com p < 0,05. RESULTADOS: a solução hidroeletrolítica proporcionou manutenção da PAS e da PAD, e menor incremento da FC durante o exercício; e promoveu retorno mais rápido da FC e conservou PAD, SpO2, PAS (a partir do 5º min) e f (a partir do 30º min) no período de recuperação. CONCLUSÃO: o protocolo de hidratação influenciou parâmetros cardiorrespiratórios de jovens durante e após a realização de atividade física submáxima de intensidade constante e longa duração.
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Abstract
Daily adequate water intake to maintain euhydration is arguably the most important nutrient requirement for humans. Within a margin of error, the body regulates the maintenance of body fluid balance and especially that of the plasma volume, through mechanisms that stimulate thirst and/or modify the rate of urine production. However, there are circumstances such as with excessive sweating during exercise in the heat, osmotic diarrhea, or excessive fluid consumption, or water intoxication where normal mechanisms of regulation may be inadequate to compensate for acute changes in hydration status and result in life threatening consequences. Health and onset of disease may be affected by the chronic hydration state of individual. The risks of colorectal cancer, nephrolithiasis in those with a history of kidney stones, and bladder cancer may be reduced by more frequent water consumption. Recent research suggests that appropriate timing of water intake around meal occasions may help reduce energy intake and contribute to maintenance of body weight in overweight individuals. Definitive benefits of hydration on cardiovascular and oral health and general immune system function remain to be determined. It is also unclear whether the health benefits of water and fluid ingestion are a function of the process of frequent fluid intake or the maintenance of a potentially expanded state of hydration.
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Affiliation(s)
- Craig A. Horswill
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Illinois,
| | - Lynn M. Janas
- Department of Nutrition, Rosalind Franklin University, North Chicago, Illinois
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Hypovolaemia-induced metabolic dysfunction, mediated in part by aldosterone and angiotensin. J Hypertens 2009; 27:2116; author reply 2116-7. [DOI: 10.1097/hjh.0b013e32832dd5a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodriguez GJ, Cordina SM, Vazquez G, Suri MFK, Kirmani JF, Ezzeddine MA, Qureshi AI. The Hydration Influence on the Risk of Stroke (THIRST) Study. Neurocrit Care 2008; 10:187-94. [DOI: 10.1007/s12028-008-9169-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 11/04/2008] [Indexed: 11/28/2022]
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Rasouli M, Kiasari AM, Arab S. INDICATORS OF DEHYDRATION AND HAEMOCONCENTRATION ARE ASSOCIATED WITH THE PREVALENCE AND SEVERITY OF CORONARY ARTERY DISEASE. Clin Exp Pharmacol Physiol 2008; 35:889-94. [DOI: 10.1111/j.1440-1681.2008.04932.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To determine if a return to normonatremia is required for symptomatology to resolve in collapsed hypernatremic runners and if intravenous (IV) administration of an isotonic solution would adversely affect serum sodium concentration ([Na+]) in collapsed normonatremic runners. DESIGN Observational study. SETTING 2006 Comrades Marathon. PARTICIPANTS 103 collapsed runners. MAIN OUTCOME MEASURE Final serum [Na] upon discharge. RESULTS 58% of all collapsed runners were hypernatremic. Hypernatremic runners reported significantly more vomiting than normonatremic runners (79 versus 34%; P < 0.001). A significant decrease in serum [Na] in hypernatremic collapsed runners occurred after the IV administration of either 1 L of 0.45% normal saline (150.5 +/- 3.5 versus 148.0 +/- 4.6; P < 0.05) or Ringers lactate solution (147.7 +/- 2.2 versus 146.2 +/- 2.1; P < 0.05). One liter of IV fluid administration caused an increase in plasma volume that was not significantly different between (1) hypernatremic runners receiving a hypotonic solution (13.5 +/- 12.7%) and (2) normonatremic runners receiving an isotonic solution (15.6 +/- 11.3%). The final serum [Na+] of hypernatremic runners was above the range for normonatremia upon discharge (>145 mmol/L). CONCLUSIONS A return to normonatremia was not required for hypernatremic runners to "recover" and be discharged from the medical tent. Vomiting either aggravated and/or facilitated the development of hypernatremia. IV administration of 1 L of either (1) a hypotonic solution to hypernatremic runners or (2) an isotonic solution to both normonatremic and hypernatremic runners did not produce any adverse biochemical or cardiovascular changes and can therefore be considered a safe and effective treatment for collapsed runners if used in this context.
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Yun AJ, Doux JD, Lee PY. Contrast nephropathy may be partly mediated by autonomic dysfunction: renal failure considered as a modern maladaptation of the prehistoric trauma response. Med Hypotheses 2005; 66:776-83. [PMID: 16330157 DOI: 10.1016/j.mehy.2005.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 10/21/2005] [Indexed: 11/19/2022]
Abstract
The mechanism behind iodinated radiocontrast nephropathy remains elusive. Direct oxidative damage is the prevailing hypothesis, but the apparent protective effect of iodine against oxidation contradicts this view. We propose that autonomic dysfunction participates in the pathogenesis of radiocontrast nephropathy and may account for other contrast-associated reactions previously attributed to allergy. Iodine, through its effects on thyroid function and chemoreceptor response to metabolic acidosis, may induce hyperadrenergia and consequently diminish renovascular flow and urine output. The renal response to adrenergia likely served an adaptive function during prehistoric evolution when trauma was a dominant source of hypovolemia and adrenergia, but the response may behave maladaptively today as evolutionarily nai ve triggers for adrenergia have emerged. Autonomic dysfunction can further impair renal function by deranging renovascular autoregulation and inducing oxidative reperfusion injury as a secondary phenomenon. Many other causes of acute renal failure such as drug toxicity, surgery, hospitalization, and diabetes may operate through hyperadrenergia, impaired renovascular autoregulation, and oxidative reperfusion injury. Dialysis, a volume reduction therapy for renal failure, can counterintuitively worsen renal dysfunction by exacerbating adrenergia, which may explain its association with accelerated atherosclerosis, inflammation, and cancer. Other examples of vicious cycles that perpetuate renal dysfunction may include renal artery stenosis, carotid stenosis, and atherosclerosis as well as the cardio-renal, hepato-renal, and pulmonary-renal syndromes. The benefits of hydration and bicarbonate in protecting renal function may operate in part through baroreceptor- and chemoreceptor-mediated reduction of sympathovagal ratio, respectively. New treatment paradigms for renal failure including pharmacologic and electro-mechanical therapies are envisioned based on autonomic remodeling, reduced sympathovagal ratio, and neuromodulation of pathways typically associated with trauma such as renin, angiotensin, vasopressin, and aldosterone.
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Affiliation(s)
- Anthony J Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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Yun AJ, Bazar KA, Gerber A, Lee PY, Daniel SM. The dynamic range of biologic functions and variation of many environmental cues may be declining in the modern age: implications for diseases and therapeutics. Med Hypotheses 2005; 65:173-8. [PMID: 15893136 DOI: 10.1016/j.mehy.2004.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2004] [Accepted: 11/08/2004] [Indexed: 12/28/2022]
Abstract
We hypothesize that declining dynamic range and variation of environmental cues may contribute to health dysfunctions, and that judicious expansion of biologic dynamic ranges may be beneficial. Three disparate examples involving the endocrine, autonomic, and musculoskeletal systems are discussed. Daytime sheltering, optical shading, and nighttime use of artificial light may reduce circadian luminal variation. The resulting melatonin alterations may contribute to systemic dysfunctions. Loss of temporal variation of other hormones may contribute to biologic dysfunctions, especially those involving the hypothalamic-pituitary axis. Reduced variation of physical exertion, environmental stressors, and thermal gradients that characterize modern lifestyles may reduce the autonomic dynamic range resulting in lowered heart rate variability and a myriad of systemic dysfunctions. The health benefits of activities such as exercise, meditation, acupuncture, coitus, and laughter may operate through increasing autonomic variability. Reduced physical exertion also accounts for declining dynamic range of musculoskeletal function. The resulting muscle atrophy, fat infiltration, and sarcomere shortening may not only have deleterious local effects, but may also be involved in systemic metabolic dysfunctions such as insulin resistance. The extent to which our endogenous systems rely on environmental variation for self-tuning and the impact that under-utilization of compensatory mechanisms has on biologic function are not well understood. Modern therapeutic approaches generally result in reversion to the mean of physiologic functions and may buffer against variation. For example, beta-blockers are given to reduce adrenergic excess, insulin to treat insulin insufficiency, serotonin-reuptake inhibitors for depression, and refractive lenses for myopia. By undermining the demand for native compensatory functions, such therapeutic strategies may actually impair future ability to respond to biologic disequilibria. Generalizing from these observations, we anticipate benefits of therapeutic and lifestyle approaches that expand, rather than reduce, the dynamic range of many biologic experiences.
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Affiliation(s)
- Anthony J Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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Yun AJ, Lee PY, Bazar KA. Paradoxical strategy for treating chronic diseases where the therapeutic effect is derived from compensatory response rather than drug effect. Med Hypotheses 2005; 64:1050-9. [PMID: 15780510 DOI: 10.1016/j.mehy.2004.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 09/17/2004] [Indexed: 11/29/2022]
Abstract
Reversing chronic conditions remains an elusive goal of medicine. The modern medical paradigm based on blocking overactive pathways or augmenting deficient pathways offers symptomatic benefit, but tolerance to therapy can develop and treatment cessation can produce rebound symptoms due to compensatory mechanisms. We propose a paradoxical strategy for treating chronic conditions based on harnessing compensatory mechanisms for therapeutic benefit. Many current drugs may be repurposed for a paradoxical indication where the therapeutic effect is derived from compensatory response, rather than drug effect. For example, although exercise is associated with acute adrenergia, paradoxical downregulation of baseline sympathovagal ratio occurs as a remodeling response. For conditions that manifest chronic sympathetic bias such as cardiovascular diseases, judicious administration of adrenergic agonists may induce compensatory downregulation of baseline sympathovagal ratio. The concept may generalize to many other diseases, especially those involving pathways which exhibit strong homeostatic tendencies such as the neurologic, immune, and endocrine systems. Careful consideration of chronobiologic features is necessary to optimize dosing strategies for modulating compensatory responses, and eccentric dosing schedules, shorter-acting formulations, or pulsatile delivery may be desirable in some cases. To what extent the effect of desensitization to current therapy is mistaken for disease progression in conditions such as diabetes, myopia, depression, and hypertension warrants investigation. The merits of combining behavioral and drug therapies such as diet-insulin therapy for diabetes and exercise-beta-blockade for cardiovascular disease should be revisited since there is a risk for exacerbating the underlying dysfunction. The reduced dynamic range of various environmental experiences and the tendency to revert to the mean through medical intervention, thermoregulation, and other modern lifestyle changes may play under-recognized roles in human diseases. Perhaps alternating agonists and antagonist may exercise the entire dynamic range of pathways and improve health.
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Affiliation(s)
- Anthony J Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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Yun AJ, Daniel SM. Sympathetic and T helper (Th)2 bias may ameliorate uterine fibroids, independent of sex steroids. Med Hypotheses 2005; 65:1172-5. [PMID: 16213989 DOI: 10.1016/j.mehy.2005.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 03/19/2005] [Indexed: 11/28/2022]
Abstract
We propose that inadequate sympathetic bias and Th2 bias in the uterine environment contributes to the formation of fibroids, independent of the sex steroid status. We also propose that fibroids represent a modern maladaptation that partly results from decreasing exposure to seminal fluid, which contains catecholalmines, transforming growth factor beta1 (TGFbeta1), aldosterone, prostaglandins, and other factors that shift the uterine environment to sympathetic and T helper (Th)2 bias. Lower risk of fibroids is associated with pre-menarche, post-menopause, pregnancy, exposure to contraceptives, smoking, earlier age of first pregnancy, shorter interval since last pregnancy, higher parity, and non-obesity. These associations are currently attributed to alterations of sex steroids. However, the association may also be explained by the observation that pre-menarche, post-menopause, pregnancy, and smoking represent periods of sympathetic and Th2 bias. Furthermore, use of contraceptives, early age of first pregnancy, short interval since last pregnancy, high parity, abnormal pap smear, and non-obesity may represent surrogates for increased sexual activity and increased exposure to seminal fluid. Catecholalmines, aldosterone, TGF, and prostaglandins are among the seminal fluid components that promote sympathetic and Th2 bias. Vasectomized copulations protect against fibroids, an observation that undermines the steroid hypothesis and supports our hypothesis. The putative mechanism of action of uterine artery embolization (UAE) for fibroid treatment is starvation of blood supply, but the extensive collaterals that protect uterine perfusion would presumably also buffer against fibroid hypoperfusion. Instead, the sympathetic and Th2 responses to UAE-related ischemia may contribute to fibroid regression. A potential explanation for the association of fibroids with intrauterine devices may be a Th1 cell-mediated immune response to the foreign body, which may also enhance the contraceptive effect. Novel methods of preventing and treating fibroids by promoting sympathetic and Th2 shift through natural, pharmacologic, and neuromodulatory means are envisioned. Fibroids are likely a modern dysfunction given the high Darwinian fitness cost of fibroid-related infertility, and may be attributable to reduced intercourse frequency. Fibroids have been observed among animals in captivity that are presumably reproductively isolated.
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Affiliation(s)
- Anthony J Yun
- Stanford University, Department of Radiology, 470 University Avenue, Palo Alto, CA 94301, USA.
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