Correction to: Flavonoid quercetin-methotrexate combination inhibits inflammatory mediators and matrix metalloproteinase expression, providing protection to joints in collagen-induced arthritis.

The original article can be found online.

Flavonoid quercetin-methotrexate combination inhibits inflammatory mediators and matrix metalloproteinase expression, providing protection to joints in collagen-induced arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of synovial tissues in joints, leading to progressive destruction of cartilage and joints. The disease-modifying anti-rheumatic drugs currently in use have side-effects. Thus, there is an urgent need for safe anti-inflammatory therapies for RA. This study aimed to evaluate the therapeutic effect of the flavonoid quercetin on arthritis in mice immunized with type II collagen (CII). An arthritis model was established in C57/BL6 mice by intradermal administration of chicken CII mixed with Freund's complete adjuvant. Quercetin (30 mg/kg orally) and methotrexate (0.75 mg intraperitoneally twice a week) were administered to investigate their protective effects against collagen-induced arthritis (CIA). Levels of tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), IL-6, and the matrix metalloproteinases (MMP), 3, and 9 were detected to assess the anti-inflammatory effect of quercetin. The mRNA expression of MMP3, MMP9, CCL2, and TNF-α was also measured by quantitative real-time PCR. Quercetin significantly alleviated joint inflammation by reducing the levels of circulating cytokines and MMPs. There was a significant decrease in the expression of TNFα and MMP genes in the ankle joints of arthritic mice. A significant reduction in the levels of knee-joint inflammatory mediators were observed with combined quercetin and methotrexate treatment. Thus, quercetin has the potential to prevent joint inflammation and could be used as an adjunct therapy for RA patients who have an inadequate response to anti-rheumatic monotherapy.

Increase in the heart rate variability with deep breathing in diabetic patients after 12-month exercise training.

Autonomic neuropathy in diabetes leads to impaired regulation of blood pressure and heart rate variability (HRV), which is due to a shift in cardiac autonomic balance towards sympathetic dominance. Lower HRV has been considered a predictor of cardiac mortality and morbidity. Deep breathing test is a simple method to measure HRV and it provides a sensitive measure of cardiac autonomic function. The effect of long-term physical activity on HRV in type-2 diabetes mellitus is inconclusive. We aimed to evaluate the effects of regular physical exercise on HRV with deep breathing in type 2 diabetes (n = 105). Thirty normotensive diabetic patients and 25 hypertensive diabetic patients underwent physical exercise program for 12 months, and the other 50 patients (22 normotensive and 28 hypertensive diabetic patients) were considered the non-exercised group. Electrocardiogram was recorded during deep breathing and HRV was measured. Regular exercise significantly increased HRV in diabetic patients with and without hypertension. The degree of the increase in HRV was greater in hypertensive diabetic patients (p < 0.01) than in normotensive diabetic patients (p < 0.05). After exercise, glycosylated hemoglobin levels were decreased in both groups of diabetic patients. Moreover, the hypertensive diabetic patients showed a decrease (p < 0.05) in blood pressure after regular exercise. Thus, regular exercise training increases HRV, suggesting that there is a shift in the cardiac sympathovagal balance in favor of parasympathetic dominance in diabetic patients. Long-term physical training may be an effective means to reverse the autonomic dysregulation seen in type 2 diabetes.

Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes.

BACKGROUND: Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved. OBJECTIVE: To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes. METHODS: Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year. RESULTS: Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM: p<0.01; IHD-DN: p<0.01). The HRV significantly decreased after one year in non-compliant patients. The regular practice of diaphragmatic breathing also improved the glycemic index in these patients. CONCLUSION: The regular practice of diaphragmatic breathing significantly improves heart rate variability with a favorable prognostic picture in ischemic heart disease patients who have diabetes. These effects seem to be potentially beneficial in the management of IHD patients with diabetes.

Efeito da respiração diafragmática sobre a variabilidade da frequência cardíaca na doença cardíaca isquêmica com diabete / Efecto de la respiración diafragmática sobre la variabilidad de la frecuencia cardiaca en la enfermedad cardiaca isquémica con diabetes / Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes

FUNDAMENTO: A diminuição da variabilidade da frequência cardíaca (VFC) está associada com um prognóstico desfavorável em pacientes com doença cardíaca isquêmica (DCI) e diabete. Ainda não foi provado em definitivo se a mudança no padrão respiratório pode modificar o fator de risco nesses pacientes. OBJETIVO: Avaliar o efeito da respiração diafragmática sobre a VFC em pacientes diabéticos com DCI. MÉTODOS: A população do estudo consistiu em 145 pacientes do sexo masculino selecionados ao acaso, dos quais 45 apresentavam DCI, 52 apresentavam DCI e diabete (DCI-DM) e 48 apresentavam DCI e neuropatia diabética (DCI-ND). A VFC foi avaliada através de ECG de 5 minutos usando o método de domínio de tempo. O grupo de intervenção foi dividido em grupo aderente e não-aderente e o seguimento foi registrado após três meses e um ano. RESULTADOS:A avaliação basal mostrou uma diminuição significante em VFC nos pacientes com doença cardíaca isquêmica com ou sem diabete (p<0,01). Os pacientes com DCI apresentavam VFC mais alta do que os pacientes com DCI-DM (p<0,01) e DCI-ND (p<0,01). Um aumento na VFC foi observado em pacientes que praticaram respiração diafragmática por três meses (DCI-DM: p<0,01; DCI-ND: p<0,05) e por um ano (DCI-DM: p<0,01; DCI-ND: p<0,01). A VFC diminuiu significantemente após um ano em pacientes não-aderentes. A prática regular de respiração diafragmática também melhorou o índice glicêmico nesses pacientes. CONCLUSÃO: A prática regular de respiração diafragmática melhora de forma significante a VFC em uma direção prognosticamente favorável em pacientes com DCI e diabete. Esses efeitos parecem ser potencialmente benéficos no manejo desses pacientes.

BACKGROUND: Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved. OBJECTIVE: To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes. METHODS: Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year. RESULTS: Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM: p<0.01; IHD-DN: p<0.01). The HRV significantly decreased after one year in non-compliant patients. The regular practice of diaphragmatic breathing also improved the glycemic index in these patients. CONCLUSION: The regular practice of diaphragmatic breathing significantly improves heart rate variability with a favorable prognostic picture in ischemic heart disease patients who have diabetes. These effects seem to be potentially beneficial in the management of IHD patients with diabetes.

FUNDAMENTO: La disminución de la variabilidad de la frecuencia cardiaca (VFC) está asociada a un pronóstico desfavorable en pacientes con enfermedades cardiaca isquémica (DCI) y diabetes. Todavía no se aprobó en definitivo si el cambio en el estándar respiratorio puede modificar el factor de riesgo en esos pacientes. OBJETIVO: Evaluar el efecto de la respiración diafragmática sobre la VFC en pacientes diabéticos con DCI. MÉTODOS: La población del estudio consistió en 145 pacientes del sexo masculino seleccionados al azar, de los cuales 45 presentaban DCI, 52 presentaban DCI y diabetes (DCI-DM) y 48 presentaban DCI y neuropatía diabética (DCI-ND). La VFC se evaluó a través de ECG de 5 minutos con el empleo del método de dominio de tiempo. El grupo de intervención se dividió en grupo adherente y no-adherente y se registró el seguimiento tras tres meses y un año. RESULTADOS: La evaluación basal reveló una disminución significante en VFC en los pacientes con enfermedades cardiaca isquémica con o sin diabetes (p<0,01). Los pacientes con DCI presentaban VFC más alta que los pacientes con DCI-DM (p<0,01) y DCI-ND (p<0,01). Un aumento en la VFC se observó en pacientes que practicaron respiración diafragmática por tres meses (DCI-DM: p<0,01; DCI-ND: p<0,05) y por un año (DCI-DM: p<0,01; DCI-ND: p<0,01). La VFC disminuyó significantemente tras un año en pacientes no-adherentes. La práctica regular de respiración diafragmática también mejoró el índice glucémico en esos pacientes. CONCLUSIÓN: La práctica regular de respiración diafragmática mejora de forma significante la VFC en una dirección pronósticamente favorable en pacientes con DCI y diabetes. Esos efectos parecen ser potencialmente benéficos en el manejo de esos pacientes.