Changes in Arterial Stiffness in Response to Blood Flow Restriction Resistance Training: A Narrative Review.

Arterial stiffness naturally increases with age and is a known predictor of cardiovascular morbimortality. Blood flow restriction (BFR) training involves decreasing muscle blood flow by applying a strap or a pneumatic cuff during exercise. BFR induces muscle hypertrophy even at low intensities, making it an appealing option for older, untrained individuals. However, BFR use in patients with cardiovascular comorbidities is limited by the increased pressor and chronotropic response observed in hypertensive elderly patients. Furthermore, the impact of BFR on vascular function remains unclear. We conducted a comprehensive literature review according to PRISMA guidelines, summarizing available data on the acute and long-term consequences of BFR training on vascular function. Although evidence is still scarce, it seems that BFR has a mild or neutral long-term impact on arterial stiffness. However, current research shows that BFR can cause an abrupt, albeit transient, increase in PWV and central blood pressure. BFR and, preferably, lower-body BFR, should be prescribed with caution in older populations, especially in hypertensive patients who have an exacerbated muscle metaboreflex pressor response. Longer follow-up studies are required to assess the chronic effect of BFR training on arterial stiffness, especially in elderly patients who are usually unable to tolerate high-intensity resistance exercises.

Atherosclerosis in the Young Adult: Fewer Hypotheses, More Facts.

Several studies have reported early atherosclerotic changes in arterial wall of young adults, although they usually become symptomatic after age 40 years. Initially, some sporadic and limited data were available to document the atherosclerotic lesions in young adults; early subclinical assessment were later possible using accurate ultrasound and other imaging techniques. Our aim was to a review of eloquent studies proving different type of atherosclerotic lesion in the young adult. Long-term follow-up and further analysis of this population demonstrated important relationship with traditional and some non-traditional, risk factors. The data comprised in the reviewed studies are arguments in favor of a more refined atherosclerotic risk assessment and appropriate preventive strategy in young adult.

Inflammatory markers in hypertensive patients and influence of some associated metabolic risk factor.

UNLABELLED: Some epidemiological studies have begun to show a possible correlation between systemic and vascular inflammation and the presence of essential hypertension, especially if it is associated with metabolic risk factors (obesity, dyslipidemia, diabetes mellitus). OBJECTIVES: The objective of this study was to evaluate the levels of C-reactive protein and fibrinogen as markers of inflammation in patients with essential hypertension, with or without associated metabolic risk factors. MATERIAL AND METHODS: The retrospective study included 200 patients separated into five groups (control, hypertension, and respectively hypertension associated with obesity, or diabetes mellitus type II non-obese or obese type II diabetes). Anamnestic and anthropometric data, blood pressure and heart rate, blood glucose, lipid profile, fibrinogen, quantitative C-reactive protein and echocardiographic parameters have been reported and compared between groups. RESULTS: Our study evaluated a total of 110 women and 90 men, each of the five groups comprising a total of 22 (55%) women and 18 (45%) males. Study of the inflammatory syndrome found the highest values of CRP in hypertensive and obese patients: 1.56 +/- 3.08 (p = 0.014) in group 3 and 0.92 +/- 1.11 (p = 0.001) in group 5 versus control group (0.30 +/- 0.36). Fibrinogen values were significantly elevated in all groups of hypertensive, demonstrating the existence of an inflammatory syndrome, even in the absence of obesity or diabetes. CONCLUSIONS: All the patients showed a statistically significant relationship between elevated CRP and fibrinogen levels and the presence of hypertension, isolated, or in combination with obesity and diabetes mellitus.

Differentiation of rheumatoid arthritis from hepatitis C-related arthropathy: case report.

Chronic virus C hepatitis records high prevalence, almost 170 million people worldwide being infected. Systemic involvement is frequent and the implication of the osteoarticular system raises various problems in properly diagnosing and treating it. Rheumatoid arthritis is the most frequent type of inflammatory polyarthritis, with a prevalence of 0.8% in the general population. The rheumatoid factor recorded high values at virus C hepatitis patients (19-80%) even in the absence of articular manifestations, its sensitivity and specificity being reduced for the rheumatoid arthritis diagnosed simultaneous with virus C hepatitis. We report a case of chronic virus C hepatitis patient which, after 30 years of evolution, presents the onset of senile rheumatoid polyarthritis. The authors discuss the usefulness dosage of anti-cyclic citrullinated peptide antibodies for establishing the differential diagnosis between rheumatoid arthritis and hepatitis C-related arthropathy and the particularities of the specific treatment when there is a hepatitis C virus associated infection.

Metachronous lung cancer--case presentation.

Multiple primary tumors can be synchronous when detected simultaneously or metachronous when detected after a variable time interval. We present the case of a 62-year-old female patient with a history of keratinized squamous cell carcinoma of the cervix, stage T3bNxM, operated, and treated by chemotherapy and radiation therapy which develops after three years a large cell neuroendocrine carcinoma of the lung detected by imaging. Of major importance in the selection of the optimal therapeutic approach was the accurate determination of the histological type of the metachronous tumor by microscopy and immunohistochemical techniques. The discrete respiratory symptoms and the absence of lung imaging screening accounted for tumor development to an inoperable stage, thus emphasizing the importance of close monitoring of the oncologic patient, thus greatly increasing their chances of survival.

Ebstein's anomaly.

Ebstein's anomaly is a rare congenital heart disease, accounting for less than 1% of all congenital heart diseases, characterized by a wide clinical, electrocardiographic, echocardiographic, anatomic and prognostic polymorphism. The disease can be fatal since birth or may remain asymptomatic until adulthood, sometimes being associated with septal defects, transposition of great vessels, preexcitation syndromes, or left ventricular noncompaction. The genetic changes underlying this syndrome are not fully known, but in the cases associating left ventricular nonompaction a mutation in MYH7 gene encoding the beta-myosin heavy chain was recently detected. The authors present 2 cases of Ebstein's anomaly with different onset and course and discuss the current clinical, electrocardiographic and echocardiographic criteria used for prognostic stratification of Ebstein disease in relation to international literature.

[Spinal tuberculosis or bone metastases? Case report]. / Tuberculoza vertebrala sau metastaze osoase? Prezentare de caz.

Tuberculosis remains one of the most important infectious disease worldwide and skeletal form has an incidence between 3% and 10%, depending on geographic area. The thoracolumbar junction is the most commonly involved in vertebral tuberculosis; some radiologic features are specifics, but other could be indistinguishable from that of lymphoma or metastases. We discuss the case of a 80-year-old man presented with a 2-month history of thoracolumbar pain, fatigability and fever. The vertebral radiography showed narrowing of the intervertebral disc space between T1 and T12, adjacent irregularity, erosion and lisis of vertebres, features visibles also on computed tomography. After the exclusion of the other causes of osteolisis, we started a standard regimen of tuberculostatic treatment and after one month of treatment the symptoms of patient improved noticeably. Other problems of diagnostic and treatment modalities of spinal tuberculosis are discussed.

[Clinical and epidemiologic study of cardiovascular complications in patients with metabolic syndrome]. / Cercetari clinico-epidemiologice asupra complicatiilor cardiovasculare aparute la pacientiii cu sindrom metabolic.

UNLABELLED: Our study aims to identify correlations between the metabolic syndrome and cardiovascular diseases determinism. MATERIAL AND METHODS: A retrospective study was carried out on a sample of 1463 patients of which 734 patients met the diagnostic criteria of cardiometabolic syndrome, admitted in the Clinic of Cardiovascular Rehabilitation, Rehabilitation Hospital, Iasi, between 01.01.2009-31.12.2009. RESULTS: The incidence of cardiometabolic syndrome has a soft predominance on the group 40-59 years (61.66%). The high level of hypertension was found in the patients group 48-69 years (53.70%) and lowest in the patients group 25-38 years (11.35%) (p = 0.001). The coronary heart diseases showed a significant difference between age groups: 48-69 years (41.80%), compared to 25-38 years (7.55%) (p = 0.003). Heart failure is part of the same age distribution curve (45%, 6.8%) (p = 0.02). CONCLUSIONS: The metabolic syndrome is a predictor of the occurrence and development cardiovascular disease.

[Systemic lupus erythematosus with neurologic onset and secondary antiphospholipid syndrome. A Case Study]. / Lupus eritematos sistemic cu debut neurologic si sindrom antifosfolipidic secundar. Caz clinic.

A 39-years-old woman was admitted to our hospital with musculoskeletal complaints (myalgias and symmetric arthralgias in proximal interphalangeal, metacarpophalangeal joints of the hands and in knees), systemic symptoms like fever, fatigue, malaise and a six months previous history of a transient ischemic attack. The presence of antibodies to double-stranded deoxyribonucleic-acid (DNA) and antiphospholipid antibodies led to the diagnosis of systemic lupus erythematosus with secondary antiphospholipid syndrome. Cerebral infarction develops significantly more often in patients with lupus and antiphospholipid antibodies, but other clinical syndromes are associated with lupus anticoagulant: cognitive dysfunction, seizures, polyneuropathy, aseptic meningitis, myelopathy.

[Evaluation of oxidative stress and enzymatic antioxidants in medium physical training of moderate arterial hypertension]. / Evaluarea stresului oxidativ si antioxidantilor enzimatici în antrenamentul fizic recuperator pe termen mediu al HTA moderate.

A group of patients with moderate hypertension (149-150/90-99 mmHg) performed physical exercise for 3 months; we determined the oxidative stress in blood samples, by calculating the level of some antioxidative markers, the enzymes SOD, CAT, GPx, MDA and comparing the results with the values obtained from a group of healthy subjects. We found an increased oxidative stress at the hypertensive patients, with initial higher values of SOD and MDA and with lower values of CAT and GPx, compared to the normal subjects. After the 3 months of physical training, the oxidative stress improved, with decreasing activity of SOD, GPx, MDA and increasing CAT, maintaining the ratio CAT/SOD and GPx/SOD superior compared to normal subjects. The clinical study proved that after 3 months of physical exercise, there wasn't any increased oxidative stress at the hypertensive patients; however, the oxidative stress is present, proved by the values of MDA, significantly higher compared to the normal subjects.

[The beneficial effect of physical training in hypertension]. / Beneficille exercitiului fizic în hipertensiunea arteriala.

Hypertension is present in epidemic proportion and is associated with a markedly increased risk of developing numerous cardiovascular disorders. All current treatment guidelines emphasise the role of nonpharmacological interventions, physical activity included, in the treatment of mild to moderate hypertension. A large number of studies have demonstrated that regular exercise reduces the incidence of hypertension. In addition to preventing hypertension, regular exercise has been found to lower blood pressure (10 mmHg average reduction in both systolic and diastolic pressure), improve lipoprotein-lipid profiles and insulin sensitivity. As part of the initial treatment, exercise is recommended for 12 months in patients with stage 1 hypertension, with no other coronary risk factors and no evidence of cardiovascular disease, and for as long as 6 months in those with other risk factor, but not diabetes. In patients with diabetes, cardiovascular disease or with stage 2 or 3 hypertension, drug therapy should be initiated first. Dynamic exercise of moderate intensity, 50-75% VO2max, (e.g. brisk walking, cycling) for 50-60 minutes, 3-5 times per week, is preferable to vigorous exercise because it appears to be more effective in lowering blood pressure. In addition to reducing hypertension, physical activity improves other cardiovascular risk factors.