BackgroundMuscle wasting and chronic inflammation are predominant features of patients with COPD. Systemic inflammation is associated with an accelerated decline in lung function. In this study, the prevalence of sarcopenia and the relationships between sarcopenia and systemic inflammations in patients with stable COPD were investigated.Materials and methodsIn a cross-sectional design, muscle strength and muscle mass were measured by handgrip strength (HGS) and bioelectrical impedance analysis in 80 patients with stable COPD. Patients (≥40 years old) diagnosed with COPD were recruited from outpatient clinics, and then COPD stages were classified. Sarcopenia was defined as the presence of both low muscle strength (by HGS) and low muscle mass (skeletal muscle mass index [SMMI]). Levels of circulating inflammatory biomarkers (IL-6 and high-sensitivity TNFα [hsTNFα]) were measured.ResultsSarcopenia was prevalent in 20 (25%) patients. Patients with sarcopenia were older, had lower body mass index, and a higher percentage of cardiovascular diseases. In addition, they had significantly higher modified Medical Research Council scores and lower 6-minute walk distance than those without sarcopenia. HGS was significantly correlated with age, modified Medical Research Council score, and COPD Assessment Test scores. Both HGS and SMMI had associations with IL-6 and hsTNFα (HGS, r=−0.35, P=0.002; SMMI, r=−0.246, P=0.044) level. In multivariate analysis, old age, lower body mass index, presence of cardiovascular comorbidities, and higher hsTNFα levels were significant determinants for sarcopenia in patients with stable COPD.ConclusionSarcopenia is very common in patients with stable COPD, and is associated with more severe dyspnea-scale scores and lower exercise tolerance. Systemic inflammation could be an important contributor to sarcopenia in the stable COPD population.

Background: Sublinical myocardial dysfunction occurs in a significant number of patients with type 2 diabetes. Assessment of ventricular long-axis function by measuring mitral annular velocities using tissue Doppler echocardiography (TDE) is thought to provide a more sensitive index of systolic and diastolic function. We hypothesised that augmentation of left ventricular (LV) longitudinal contraction and relaxation during exercise would be blunted in patients with type 2 diabetes. Methods: Mitral annular systolic (S9) and early diastolic (E9) velocities were measured at rest and during supine bicycle exercise (25 W, 3 min increments) in 53 patients (27 male, mean age 53¡14 years) with type 2 diabetes and 53 subjects with age and gender-matched control. None had echocardiographic evidence of resting or inducible myocardial ischaemia. Results: There were no significant differences in mitral inflow velocities at rest between the two groups. E9 and S9 at rest were also similar between the groups. However, S9 (7.1¡1.3 vs 8.3¡1.8 cm/s at 25 W, p = 0.0021; 8.1¡1.5 vs 9.1¡2.0 cm/s at 50 W, p = 0.026) and E9 (8.5¡2.3 vs 9.9¡3.1 cm/s at 25 W, p = 0.054; 9.1¡2.1 vs 10.9¡2.5 cm/s at 50 W, p = 0.0093) during exercise were significantly lower in patients with diabetes compared with controls. Longitudinal systolic and diastolic function reserve indices were significantly lower in patients with diabetes compared with that of controls (systolic index, 0.6¡0.70 vs 1.2¡1.5 cm/s at 25 W, p = 0.029; 1.2¡1.2 vs 2.1¡1.6 cm/s at 50 W, p = 0.009; diastolic index, 1.9¡1.2 vs 2.5¡2.2 cm/s at 25 W, p = 0.07; 2.3¡1.3 vs 3.2¡2.2 cm/s at 50 W, p = 0.031). Conclusion: In conclusion, unlike resting mitral inflow and annular velocities, changes of systolic and diastolic velocities of the mitral annulus during exercise were significantly reduced in patients with type 2 diabetes compared with the control group. The assessment of LV longitudinal functional reserve with exercise using TDE appears to be helpful in identifying early myocardial dysfunction in patients with type 2 diabetes.

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Background. Pain is an important problem for patients with cancer and is particularly important for elderly patients with cancer and their family care givers. Increasingly, cancer is managed on an outpatient basis with pain management responsibility assumed by the family at home. This study evaluated a structured pain education program that included three components: basic pain management principles and assessment, pharmaco‐logic interventions, and nondrug treatments. Methods. The pain education intervention was implemented across three home visits with two paints of follow‐up evaluation. Outcomes of the 66 elderly patients with cancer completing the educational program included measures of quality of life, patient knowledge and attitudes regarding pain, and use of a self‐care log to document drug and nondrug interventions and their effectiveness. Results. Repeated measurement analysis was used to evaluate the outcomes of the three‐part education intervention. Results indicate an improvement in knowledge and attitudes regarding pain as well as the use of drug and nondrug interventions. Outcomes of the quality of life instrument suggest significant effect of pain on all aspects of quality of life, including physical well being, psychological well being, social concerns, and spiritual well being. Conclusions. The investigators concluded that the pain education intervention provided important support to elderly patients with cancer and family members at home. Structured pain education based on an evolving science of pain relief should become a part of the standard health care for pain management. Improved pain management includes quality of life for the elderly patient with cancer as well as for family care givers.

Black raspberry (Rubus occidentalis) has been known for its anti-inflammatory and anti-oxidant effects. However, short-term effects of black raspberry on lipid profiles and vascular endothelial function have not been investigated in patients with metabolic syndrome. Patients with metabolic syndrome (n = 77) were prospectively randomized into a group with black raspberry (n = 39, 750 mg/day) and a placebo group (n = 38) during a 12-week follow-up. Lipid profiles, brachial artery flow-mediated dilatation (baFMD), and inflammatory cytokines such as IL-6, TNF-α, C-reactive protein, adiponectin, sICAM-1, and sVCAM-1 were measured at the baseline and at the 12-week follow-up. Decreases from the baseline in the total cholesterol level (-22.8 ± 30.4 mg/dL vs. -1.9 ± 31.8 mg/dL, p < 0.05, respectively) and total cholesterol/HDL ratio (-0.31 ± 0.64 vs. 0.07 ± 0.58, p < 0.05, respectively) were significantly greater in the group with black raspberry than in the placebo group. Increases in baFMD at the 12-week follow-up were significantly greater in the group with black raspberry than in the placebo group (0.33 ± 0.44 mm vs. 0.10 ± 0.35 mm, p < 0.05, respectively). Decreases from the baseline in IL-6 (-0.4 ± 1.5 pg/mL vs. -0.1 ± 1.0 pg/mL, p < 0.05, respectively) and TNF-α (-2.9 ± 4.7 pg/mL vs. 0.1 ± 3.6 pg/mL, p < 0.05, respectively) were significantly greater in the group with black raspberry. The use of black raspberry significantly decreased serum total cholesterol level and inflammatory cytokines, thereby improving vascular endothelial function in patients with metabolic syndrome during the 12-week follow-up.