Age-related impaired proliferation of peripheral blood mononuclear cells is associated with an increase in both IL-10 and IL-12

Reflective of age-associated decline in immune function among elderly individuals is a decrease in in vitro T cell proliferative ability. Impaired T cell proliferation in the elderly may result from disruption of the well-balanced network of regulatory cytokines produced during an immune response. The purpose of this study was to identify age-related changes in the production of interleukin (IL)-10 and IL-12, and to determine whether in vitro T cell proliferation can be enhanced in the elderly by modulation of these two key cytokines. The superantigen Staphyloccocus entertoxin B (SEB) was used to stimulate proliferation and IL-10 and IL-12 production in peripheral blood mononuclear cells (PBMC) in vitro. Proliferation was determined by standard tritiated thymidine uptake. Cytokine levels in culture supernatants were measured by ELISA. We observed impaired SEB-induced proliferation of PBMC in the elderly that is comparable to that seen with the polyclonal mitogen Con A. This age-related decline in proliferation was associated with increased production of both IL-10 and IL-12. Modulation of PBMC proliferative response with either recombinant IL-12 or IL-10-neutralizing antibodies can boost proliferation of elderly PBMC to the levels seen in unmodulated young controls.

Antigen presenting cell function is enhanced in healthy elderly

Aging is associated with a progressive decline in T cell-mediated immune responses. Little is known about the effect of aging on antigen presenting cells (APC). We have recently reported an age-related decline in proliferative response of peripheral blood mononuclear cells from elderly volunteers to Staphylococcus enterotoxin B (SEB). Since SEB-induced stimulation of T cells is not restricted by major histocompatibility complex, experiments were conducted in which T cells and APC from young and healthy elderly subjects were combined. We initially demonstrated the decreased SEB-induced proliferative capacity of elderly T cell elderly APC co-cultures when compared with young T cell young APC co-cultures. Combination of purified T cells from elderly donors with APC from young donors maintained a reduced T cell proliferative response. Age-related decline in T cell function was also established by the reduced proliferative capacity of elderly T cells co-cultured with a reference monocyte cell line. Surprisingly, co-culture of APC from healthy elderly donors with purified T cells from young donors enhanced T cell proliferation. APC from elderly donors also marginally enhanced the proliferative response of an SEB-specific T cell line.

Prospective evaluation of transesophageal pacing for the interruption of atrial flutter

PURPOSE

Although transesophageal pacing has been used successfully for the interruption of cardiac arrhythmias, the efficacy of this technique for the interruption of spontaneous atrial flutter remains poorly defined. The utility of transesophageal pacing to interrupt atrial flutter that was persistent despite standard antiarrhythmic drug therapy (mean duration: 70.3 days; range: one day to more than 365 days) was studied prospectively in 39 consecutive patients.

PATIENTS AND METHODS

After written informed consent was obtained from each patient, transesophageal pacing was performed with a programmable stimulator, using the distal electrode as the cathode and the proximal electrode as the anode. All patients continued to receive a type 1 antiarrhythmic drug or amiodarone throughout the period of transesophageal pacing. The response to transesophageal pacing was classified as follows: (1) direct conversion; (2) indirect conversion; or (3) failure to interrupt atrial flutter.

RESULTS

The mean stimulus amplitude and pulse duration required for atrial capture were 19.8 +/- 7.5 mA and 18.4 +/- 7.9 msec. Atrial flutter was successfully converted to sinus rhythm by transesophageal pacing in 82% of patients. In 38% of patients, atrial flutter was converted directly to sinus rhythm without another intervening arrhythmia (direct conversion). The mean pacing rate required for direct conversion was 341 +/- 27 beats/minute. In 44% of patients, the cycle length of atrial flutter was accelerated to less than 180 msec or was converted to atrial fibrillation with spontaneous conversion to sinus rhythm within 24 hours (mean 8.4 +/- 9.3 hours, indirect conversion). The mean pacing rate inducing accelerated atrial flutter or transient atrial fibrillation was 372 +/- 61 beats/minute (p = NS compared to direct conversion). Atrial flutter was not interrupted or atrial fibrillation was induced that did not spontaneously convert to sinus rhythm within 24 hours in an additional seven patients (18%). The underlying cardiac disease, age, previous drug therapy, atrial size, atrial flutter cycle length, history of prior atrial fibrillation, left ventricular function, and concomitant medical illnesses did not predict the efficacy of transesophageal pacing.

CONCLUSION

The present study suggests that transesophageal pacing is highly effective for interrupting spontaneous atrial flutter that does not terminate with standard antiarrhythmic drug therapy.

Relation of peri-infarction block to ventricular late potentials in patients with inferior wall myocardial infarction

This study explores the relation of the presence of peri-infarction block to ventricular late potentials in patients with inferior wall myocardial infarction (MI). The hypothesis was that both the gross peri-infarction block pattern and subtle low-level ventricular late potentials are expressions of conduction abnormality associated with infarction. The consequent question arose whether peri-infarction block may have the same association with sustained ventricular arrhythmias that has been demonstrated in postinfarction patients with ventricular late potentials. Seventy patients with documented Q-wave MI were divided into those with (23) and those without (47) peri-infarction block. Signal-averaged electrocardiograms were obtained. Analysis of the vectormagnitude complex revealed that the total duration of that complex and the duration of terminal potential under 40 microV in the peri-infarction group exceeded that in the group without peri-infarction block (p less than 0.0001). The voltage in the last 40 ms of the vectormagnitude complex was also significantly less in the peri-infarction group (p less than 0.0005). There were 13 instances of sustained ventricular tachycardia, ventricular fibrillation or sudden death occurring subsequent to infarction not associated with the acute ischemic event, 11 of which occurred in the peri-infarction group. The significantly higher incidence of late potentials along with the significantly higher incidence of sustained ventricular arrhythmias in the peri-infarction block on the surface electrocardiogram may provide another marker for identifying persons at increased risk for these arrhythmias subsequent to MI.

Involution of the postpartum uterus: an ultrasonic study

The involution of the uterus was studied between 1 and 40 days postpartum utilizing serial ultrasonic scans. All pregnancies and postpartum periods were uncomplicated. The decrease in uterine size was related to a diminution in uterine length. No difference was observed between nullipara and primipara or breast- or bottle-feeding mothers.

Possible triggering of paroxysmal atrial fibrillation in normal hearts by psychological stressors: a report of two cases

Paroxysmal atrial fibrillation was triggered by psychological stress in two patients, both of whom had normal echocardiograms and coronary angiography. Neither patient was alcoholic or had ingested ethanol in relation to the onset of atrial fibrillation and both were free of metabolic derangements. Possible mechanisms involved in the triggering of atrial fibrillation are discussed.

Dizziness and the autonomic dysfunction syndrome

Dizziness resulting from inner ear or CNS disease has been well described. However, there is a large number of patients for whom dizziness does not seem to be related to either the ears or the CNS. We postulate an abnormality in the autonomic nervous system of such patients and have used standard tilt testing and Valsalva methods to assess the abnormality. Based on the results of these tests, we can suggest therapeutic options.

Resolving behaviour problems in preschool children: evaluation of a workshop for health visitors

Workshops on helping parents resolve behaviour problems in their preschool child were provided for all health visitors from one health district in Bristol, UK. An emphasis was placed upon engaging the parents as behaviour change agents, whilst providing a constructional approach to the treatment of this type of problem. The course was evaluated 3 months later. Results are discussed in terms of usefulness of course content as perceived by the health visitors, reported alterations to their health visiting practice and implications for future liaison between clinical psychologists and health visitors.

What do health visitors gain from behavioural workshops?

Health visitors' ratings of their role, competence, methods and effectiveness in resolving each of seven common types of preschool behaviour problem were obtained both prior to attending a behavioural training workshop and about 9 months later. At follow-up a structured interview examined their current practice in relation to preschool behaviour problems. Results suggest that these experienced health visitors perceived themselves as reasonably self-sufficient in dealing with these problems prior to training. Training had a significant but consolidating effect on these views. Possible mismatches between the health visitor's view of herself as a behaviour change agent and her training experiences in behavioural methods are examined and some suggestions are made regarding future liaison between health visitors and clinical child psychologists.

Dizziness due to dysautonomia: response to specific therapy

We have reported a case of hypervagal dysautonomia in which there was improvement in the results of autonomic nervous system tests (ANSTs) as well as in the patient's symptoms. This patient is one of more than 200 patients who have had our testing protocol. Although a high percentage of autonomic dysfunction was detected in this group of patients, we do not suggest that these tests be applied routinely to every patient complaining of dizziness. Rather, ANSTs should be selectively administered after otologic disease has been excluded and when dizziness is accompanied by various other symptoms.

Conflicts of interest in electrophysiology and devices presentations

AIMS

Industry collaboration with arrhythmia and devices research is common. However, this results in conflicts of interest (CoI) for researchers that should be disclosed. This study aimed to examine the quality of CoI disclosures in arrhythmia and devices presentations.

METHODS

Recorded presentations from the Arrhythmia & Devices section of the ESC Annual Congress 2016-2020 were assessed. The number of words, conflicts, and time displayed was documented for CoI declarations. Meta-data including sponsorship by an industry partner, presenter sex, and institution were obtained.

RESULTS

Of 1153 presentations assessed, 999 were suitable for inclusion. CoI statements were missing from 7.2% of presentations, and 58% reported ≥1 conflict. Those with conflicts spent less time-per-word on their disclosures (median 150 ms, interquartile range [IQR] 83-273 ms) compared with those without conflicts (median 250 ms, IQR 125-375 ms). One-in-eight presentations were sponsored (12.8%, n = 128). CoI statements were more likely to be missing in sponsored presentations (14.8%, n = 19) compared with non-sponsored presentations (6.1%, n = 53), P = 0.0003. Sponsored presentations contained a greater median number of CoIs (10, IQR 6-18) compared with non-sponsored sessions (1, IQR 0-5), P < 0.0001. Time-per-word spent on COI disclosures was 50% lower in sponsored sessions (125 ms, IQR 75-231 ms) compared with non-sponsored sessions (250 ms, IQR 125-375 ms), P < 0.0001.

CONCLUSION

The majority of those presenting arrhythmia and devices research have CoIs to declare. Declarations were often missing or displayed for short periods of time. Presenters in sponsored sessions, while being more conflicted, had a lower standard of declaration suggesting a higher risk of potential bias which viewers had insufficient opportunity to assess.

Sleep problems in pre-school children

Records were kept by one health visitor on the progress of nine children with sleeping difficulties. All the children were from socially disadvantaged families. The results reveal that the individual constructional treatment programmes which were applied by the health visitor were effective within a brief period and were not costly. Implications for health visiting practice are discussed and further issues about behavioural treatment and service delivery raised.

Recent graduates' evaluation of their dental school education

To assess recent dental graduates' perceptions about the adequacy of their education, a random sample of individuals who graduated between 1980 and 1982 was surveyed. The 362 respondents (56 percent response rate) indicated their perceived level of preparedness and the importance to practice of 75 topics in the dental school curriculum. The means for level of preparedness and importance to practice were plotted for each of the 75 topics. Those topics that new dentists believed to be underemphasized or overemphasized in the curriculum were identified. These findings have implications for planning curricular changes for dental education.

Does industry funding differ between men and women in electrophysiology and devices research?

Funding Acknowledgements

Type of funding sources: None.

Background

A significant gender bias has been identified in cardiology. Industry funding may be important developing electrophysiology (EP) and devices research. Such funding leads to potential conflicts of interest (COI) which must be disclosed on research presentations. There is limited evidence whether the gender bias in cardiology extends to industry funding of research.

Purpose

To assess whether COI disclosures in EP and devices presentations at the ESC Annual Congress differ between men and women.

Methods

Recorded presentations from the Arrhythmia & Devices section of ESC Annual Congresses 2016-2020 were assessed. Presentations were excluded if the original presentation contained no slides, it was a panel discussion, it was a non-scientific presentation, or part of the presentation was missing. Presentations with multiple speakers were also excluded. Chi-squared and Mann-Whitney U tests were used to assess differences between groups for dichotomous and continuous data respectively.

Results

Of 1,153 presentations assessed, 999 were suitable for inclusion. Women made up 22% (n = 221) of presenters. There was no difference in whether COI declaration slides were missing between women (5.9%, n = 13) and men (7.6%, n = 56), p = 0.38. In those with COI disclosure slides (n = 927), women declared significantly lower median number of COIs (0, IQR 0-3) compared with men (2, IQR 0-8), p &lt; 0.0001. In contrast, women spent a greater time-per-word on their COI disclosure slides (250ms, IQR 125-375ms) compared with men (200ms, IQR 118-333ms), p &lt; 0.0001.

Conclusions

Women made up a minority of presenters in EP/devices talks at the ESC annual congress. Women were less likely to have COIs which may suggest that they are less likely to receive industry funding. Despite this, women spent a greater amount of time-per-word on their COI slides. The lower number of declared COIs in women highlights another potential area of gender bias in cardiology that needs further investigation so that it can be addressed.