The Effect of Opioids and Benzodiazepines on Exacerbation Rate and Overall Survival in Patients with Chronic Obstructive Pulmonary Disease on Long-Term Non-Invasive Ventilation.

: There is a growing concern that opioids and benzodiazepines can depress the respiratory drive and could contribute to worsening respiratory failure and higher exacerbation frequency in COPD. However, the relationship between the exacerbation rate and medication taken is poorly understood in patients with chronic respiratory failure due to COPD. : As part of a service evaluation project, we analysed 339 patients with COPD who were established on long-term non-invasive ventilation (LT-NIV) at our tertiary centre.

Periodic limb movements in sleep in patients using antidepressants.

Depression and periodic limb movement disease are both common disorders which frequently co-exist. Furthermore, antidepressants are known to cause and worsen periodic limb movements in sleep, which can worsen the quality of sleep and subsequently daytime symptoms. However, the effect of antidepressants on periodic limb movements is not uniform and depends on their mechanism of action.

Alpha-synuclein supports type 1 interferon signalling in neurons and brain tissue.

The protein alpha-synuclein is predominantly expressed in neurons and is associated with neurodegenerative diseases like Parkinson's disease and dementia with Lewy bodies. However, the normal function of alpha-synuclein in neurons is not clearly defined. We have previously shown that mice lacking alpha-synuclein expression exhibit markedly increased viral growth in the brain, increased mortality and increased neuronal cell death, implicating alpha-synuclein in the neuronal innate immune response.

Atrial fibrillation in cardiac resynchronization therapy patients: should we ablate the atrioventricular node?

Prevalence of persistent atrial fibrillation in patients undergoing cardiac resynchronization therapy remains high. Several factors, including suboptimal biventricular capture rates, compound the significant mortality and response rates in patients with atrial fibrillation and severe heart failure. Atrioventricular nodal ablation provides the best mean of rate control in this population.

Submaximal effort tolerance as a predictor of all-cause mortality in patients undergoing cardiac rehabilitation.

Background: Submaximal effort tolerance is routinely available during cardiac rehabilitation, but its prognostic value in relation to underlying referral diagnosis is not known.

Hypothesis: Treadmill effort capacity during submaximal exercise training predicts all-cause mortality after cardiac rehabilitation.

Methods: We followed 600 consecutive patients (450 men and 150 women, mean age 65 years) who were referred to a 12-week outpatient program of cardiac rehabilitation; 37% had a prior myocardial infarction (MI), 44% had a recent percutaneous intervention (PCI), and 39% had history of coronary artery bypass surgery (CABG).

Randomized, controlled dose-ranging study of the selective adenosine A2A receptor agonist binodenoson for pharmacological stress as an adjunct to myocardial perfusion imaging.

Background: Dipyridamole and adenosine cause frequent side effects as a result of nonspecific adenosine receptor stimulation. Selective agonism of the adenosine A2A receptor should result in a similar degree of coronary vasodilation (and thus similar perfusion images) with fewer side effects.

Methods And Results: In a multicenter, randomized, single-blind, 2-arm crossover trial, 240 patients underwent 2 single photon emission computed tomographic (SPECT) imaging studies in random order, first after pharmacological stress with adenosine and a second study with the selective adenosine A2A receptor agonist binodenoson, using 1 of 4 dosing regimens.

Effect of age and gender on heart rate recovery after submaximal exercise during cardiac rehabilitation in patients with angina pectoris, recent acute myocardial infarction, or coronary bypass surgery.

The effect of exercise training on the heart rate recovery (HRR) response to submaximal effort was examined in 81 patients during 12 weeks of phase II cardiac rehabilitation. Although HRR after submaximal effort was relatively reduced in older patients with heart disease and in women, its increase during exercise training in men and women of all ages was consistent with enhancement of parasympathetic tone during activities of daily living.