Effect of pioglitazone on cardiac sympathovagal modulation in patients with type 2 diabetes.

This study aims to examine the effect of pioglitazone on potential progression of autonomic damage in addition to changes in control of cardiovascular function in patients with type 2 diabetes (T2DM). Thirty patients with T2DM and 32 healthy subjects participated in the study. Sympathovagal activity, assessed by power spectral analysis (PSA) of R-R intervals variability, and blood pressure (BP) were studied during clinostatism and orthostatism in controls and patients. We have assessed blood pressure control by 24-hour monitoring of ambulatory blood pressure. Patients were treated with pioglitazone (30 mg/day) for 6 months, and then re-evaluated by PSA for heart rate variability (HRV). Reduced levels of HbA1c (P < 0.0001) and urinary albumin (P = 0.008) were observed in pioglitazone-treated patients compared to untreated baseline levels. Arterial BP remained unchanged following pioglitazone treatment. T2DM patients had reduced HRV (low-frequency power; LF; P < 0.0001 and LF/HF; LF/HF; P < 0.0001) at baseline (clinostatism) compared to controls. Baseline clinostatic differences between groups persisted after pioglitazone treatment and no effect of treatment on basal HRV variables was observed. In controls, HF decreased and LF and LF/HF ratio increased in the orthostatic position. A similar effect for HF was observed in patients, but LF and LF/HF did not increase. The normal difference between HF-power in clinostatism versus orthostatism observed for controls (P < 0.0001) was restored in patients following pioglitazone treatment (P = 0.028). A significant decrease from lying to standing position in orthostatic LF-power (P < 0.0001) and LF/HF (P < 0.0001) was also observed between patients and controls. Although no differences in autonomic control of HRV were observed between controls and patients with T2DM, significant differences were observed in sympathovagal balance following either clinostatic or orthostatic challenge. These findings provide initial evidence of a potential additional benefit afforded by pioglitazone for the improvement of cardiac sympathovagal balance in T2DM.

Sympathovagal imbalance in transsexual subjects.

CONTEXT: Autonomic nervous system imbalance is related to cardiovascular risk. Heart rate variability (HRV) indexes are associated with age, race, and sex, but the role of sex hormones is still unknown. OBJECTIVE: To evaluate sympathovagal balance (SB) in transsexuals. PATIENTS: Eighteen transsexual subjects, 12 male-to-female (group 1) and 6 female- to-male (group 2), compared with 34 age-matched controls: 17 males (group 3) and 17 females (group 4). Autonomic testing of SB was performed by Power Spectral Analysis (PSA) of HRV in clinostatism (c) and orthostatism (o). PSA identifies power peaks: high frequency (HF) expresses vagal activity, while low frequency (LF) expresses sympathetic activity. RESULTS: Group 1 showed lower LFc than groups 2, 3, and 4 (p<0.001, p=0.05, p<0.001, respectively), and lower LFo than groups 3 and 4 (p=0.01); HFc was lower than in groups 2, 3, and 4 (p=0.02, p=0.02, p<0.001, respectively), and HFo was lower than in groups 3 and 4 (p<0.001). LFo/HFo ratio was higher in group 1 than in group 4 (p<0.001). No differences emerged between groups 2 and 3. Group 2 showed lower HFo than group 4 (p=0.03), and a higher LFo/HFo ratio (p=0.01). Group 3 showed lower HFo and HFc than group 4 (p=0.02, p=0.05, respectively), and a higher LFo/HFo ratio (p=0.03). CONCLUSION: In this study we found a sympathovagal imbalance due to a reduced sympathetic and parasympathetic influence on heart rate. Sex hormone therapy per se may play a role in this imbalance, and HRV measurement could be useful in detecting cardiovascular risk in transsexuals.

Alterations in the autonomic control of heart rate variability in patients with anorexia or bulimia nervosa: correlations between sympathovagal activity, clinical features, and leptin levels.

Changes in body composition, hormone secretions, and heart function with increased risk of sudden death occur in eating disorders. In this observational clinical study, we evaluated sympathovagal modulation of heart rate variability (HRV) and cardiovascular changes in response to lying-to-standing in patients with anorexia (AN) or bulimia nervosa (BN) to analyze: a) differences in autonomic activity between AN, BN, and healthy subjects; b) relationships between autonomic and cardiovascular parameters, clinical data and leptin levels in patients with eating disorders. HRV, assessed by power spectral analysis of R-R intervals, blood pressure (BP) and heart rate (HR) were studied by tilt-table test in 34 patients with AN, 16 with BN and 30 healthy controls. Autonomic and cardiovascular findings were correlated with clinical data, and serum leptin levels. Leptin levels were lowered in AN vs BN and healthy subjects (p<0.0001), but both AN and BN patients showed unbalanced sympathovagal control of HRV due to relative sympathetic failure, prevalent vagal activity, impaired sympathetic activation after tilting, independently from their actual body weight and leptin levels. No significant correlations were obtained between HRV data vs clinical data, BP and HR findings, and leptin levels in eating disorders. Body mass indices (BMI) (p<0.02), and leptin levels (p<0.04) correlated directly with BP values. Our data showed alterations of sympathovagal control of HRV in eating disorders. These changes were unrelated to body weight and BMI, diagnosis of AN or BN, and leptin levels despite the reported effects of leptin on the sympathetic activity.

Microbiological study of cosmetic products during their use by consumers: health risk and efficacy of preservative systems.

AIM: To evaluate the microbial contamination of 91 cosmetics (23 o/w emulsions, 47 tensiolytes, 21 aqueous pastes) in three different states of use (intact, in-use, ending product) and the protection efficacy of the preservative systems most frequently used in the analysed cosmetic formulations. METHODS AND RESULTS: Total bacterial count, isolation and identification of pathogenic isolates were performed on the collected cosmetics. About 10.6% of tensiolytes (13.5% bath foam, 6.7% shampoo, 10% liquid soaps) were contaminated by Staphylococcus warneri, Staphylococcus epidermidis and Pseudomonas putida. The efficacy of the preservative systems of two cosmetic products, tested against standard micro-organisms (Staphylococcus aureus ATCC 4338 and Pseudomonas aeruginosa ATCC 9027) and two isolates from cosmetics in this study (S. epidermidis and P. putida), satisfied the Cosmetics, Toiletries, and Fragrance Association and Official Italian Pharmacopeia criteria, while only one tested cosmetic respected the Rapid Challenge Test criterion. CONCLUSIONS: Contaminated cosmetic products are relatively uncommon, but some products, unable to suppress the growth of several micro-organisms, represent a potential health hazard. SIGNIFICANCE AND IMPACT OF THE STUDY: The challenge test may be performed not only during the preparation of the preservative system in the intact cosmetics, but also be used to evaluate the protection efficacy during their use.

Effects of recombinant human thyrotropin on heart rate variability and blood pressure in patients on l-thyroxine-suppressive therapy for differentiated thyroid carcinoma.

BACKGROUND: Recombinant human thyrotropin (rhTSH) is now currently used for the follow-up of patients with differentiated thyroid carcinoma (DTC) after total thyroid ablation. Side effects after rhTSH could involve the autonomic system and TSH receptors are possibly expressed in the heart and coronary arteries. METHODS: Heart rate variability (HRV), studied by power spectral analysis of low (LF) and high frequency (HF) powers, blood pressure (BP) and their responses to orthostatism were investigated before and 3, 6, 9 days after the first of two administrations of rhTSH on alternate days in 11 patients on chronic l-thyroxine (l-T4) suppressive therapy for DTC and in 31 healthy controls. RESULTS: A transient asymptomatic decrease in systolic and mean BP was observed during the rhTSH test, but rhTSH did not modify sympathovagal control of HRV and the lying to standing responses. Decreased LF power and LF/(LF + HF) and LF/HF ratios in DTC patients versus healthy controls indicated a sympathetic failure ascribed to the TSH-suppressive therapy with l-T4 rather than to direct effects of rhTSH. CONCLUSIONS: These findings allowed us to confirm the cardiovascular safety of rhTSH and the absence of its effects on sympathovagal control of HRV when used in the follow-up of patients with normal heart function after thyroid ablation for DTC.

Adhesion of ectomycorrhizal bacteria to plant cells: an in vitro evidence.

In this study we have investigated, by combining microbial and microscopical techniques, the adhesion ability of bacteria present in Tuber borchii ectomycorrhizosphere. Our data demonstrate that a common pool of bacteria - Pseudomonas, Bacillus, Micrococcus and Moraxella - occurs in all ectomycorrhizal homogenates and that most of these bacteria are able to attach in vitro to plant cells.

Spectral analysis of R-R interval variability by short-term recording in anorexia nervosa.

Subjects with anorexia nervosa (AN) present a number of changes in autonomic system functions, such as thermoregulation, vascular motility, heart rate and rhythm, and blood pressure. We evaluated the changes in the autonomic control of heart rate and blood pressure after postural variation by means of the spectral analysis of R-R interval variability (HRV in 13 female subjects with AN diagnosed on the basis of diagnostic statistical manual (DSM-IV) criteria, a mean age of 25 +/- 5.8 years and a mean body mass index (BMI) of 16.9 +/- 2.6. The controls were 16 healthy female subjects with a mean age of 25 +/- 2.3 years and a normal BMI. The data were statistically evaluated by means of one-way analysis of variance or Student's t test. The high frequency (HF) components of the spectral analysis did not significantly change when passing from clino- to orthostatism in the AN subjects, but there were significant changes in the controls. The changes in the low frequency (LF) components were similar in both groups, but smaller in the AN subjects. However, the difference between the two series was not statistically significant. The variance in the orthostatic R-R intervals recorded in the AN subjects was significantly less than the clinostatic intervals, the intervals recorded in the controls. These results indicate that AN subjects show signs of autonomic dysfunction. The increase in the HF component of the spectral analysis suggests that parasympathetic modulation is abnormally persistent during orthostatism, furthermore, the variability of the R-R intervals indicates that orthosympathetic regulation is also altered in AN.

Association between drinking water disinfection and somatic parameters at birth.

We conducted an epidemiological study in Liguria, Italy, on the association between somatic parameters at birth and drinking water disinfection with chlorine dioxide and/or sodium hypochlorite. Over 2 years (1988-1989), 676 births at two public hospitals, one in Genoa (548 cases) and another in Chiavari (128 cases) were examined and data regarding both mother and child were obtained from hospital records. Results indicate a higher frequency of small body length (< or = 49.5 cm) and small cranial circumference (< or = 35 cm) in infants born to mothers who drank water treated with chlorine compounds. In particular, the statistical analysis (by simultaneous variance analysis and Scheffé test) indicated that there may be an association between infants with smaller body length and mothers who drank water treated with chlorine dioxide [adjusted odds radio (OR) = 2.0; 95% CI = 1.2-3.3] or sodium hypoclorite (adjusted OR = 2.3; 95% CI = 1.3-4.2) and between infants with smaller cranial circumference and mothers who drank water treated with chlorine dioxide (adjusted OR = 2.2; 95% CI = 1.4-3.9) or sodium hypochlorite (adjusted OR = 3.5; 95% CI = 2.1-8.5). The presence of neonatal jaundice is almost twice as likely (adjusted OR = 1.7; 95% CI = 1.1-3.1) in infants whose mothers drank water treated with chlorine dioxide.

[Hygiene problems associated with characteristics of the sludge from purification plants in Liguria]. / Problemi igienici associati alle caratteristiche dei fanghi provenienti dagli impianti di depurazione in Liguria.

Sludge samples from five municipal sewage treatment plants in Liguria (Italy) were examined periodically during a whole year. Four of them are located in Genova and receive the sewage corresponding respectively to 20,000-53,000-125,000 and 285,000 equivalent inhabitants. The last one is in Chiavari and receives the sewage corresponding to 40,000 equivalent inhabitants. All plants included a preliminary screening treatment, primary sedimentation and a secondary activated sludge process. Sludge was thickened by centrifuge. The bacteriological and chemical characteristics of the sludge after centrifuging (detection and estimation of total and fecal coliforms, fecal streptococci and enumeration and isolation of Salmonella, pH, moisture, total and volatile residue, nitrogen, phosphorus, heavy metals) were measured in order to establish the possibility of land disposal. Dry solids contained on average 34 g/kg total nitrogen and 1,4 g/kg phosphorus. Among heavy metals copper and zinc reached high levels: 544 and 1587 mg/kg of dry solids. Other metals were present at lower concentrations (As 6, Cd 2, Cr 70, Hg 2, Ni 53, pb 416 mg/kg). Comparing these results with those of a research carried out contemporarily in another region (Emilia Romagna) it was observed that in Ligury there is a higher content of copper and bacteria (with an average of 69 Salmonella in 1 g of dry solids). The results showed that sludge produced in the five treatment plants in Ligury (Italy) was apt to be used as fertilizer in soil, but that care has to be taken for what concerns microbial contamination. For what regards the differences among the five sewage treatment plants under observation some heavy metals (arsenic and chromium) reached very high average levels (10-14 mg/kg of arsenic and 70-118 mg/kg of chromium) in the sludge of two of them, which treat the sewage from highly industrialized areas. On the contrary lead and cadmium were present at the same levels in all plants (416 mg/kg of lead and 2 mg/kg of cadmium) with the exception of one (Ge-Quinto) where cadmium was practically absent (0,2 mg/kg). The overall average concentrations of heavy metals resulted definitively lower than maximum concentration proposed by CEE (1986) and by some italian region as Lombardia. Some differences among plants for what regards microbiological parameters were noted only for total coliforms.

Repeated seizures induce long-term increase in hippocampal benzodiazepine receptors.

Repeated seizures, whether induced by kindling or electroshock, caused a long-lasting (at least 24 hr) increase of [3H]diazepam binding in hippocampal membranes of Sprague-Dawley rats. Scatchard analyses demonstrated that increased numbers of binding sites accounted for the increase. Neither repeated hypoxia nor repeated administration of electrical current without inducing seizures caused an increase of [3H]diazepam binding. Regardless of the method used for seizure induction, the response was graded in that large numbers of seizures were required to induce significant increases, whereas fewer seizures induced only slight increases. We suggest that the receptor increases imply a heightened response to benzodiazepines and more powerful hippocampal recurrent inhibition.