Cardio-respiratory fitness is independently associated with cardio-metabolic risk markers in severely obese women

INTRODUCTION

Many studies have shown an inverse relationship between cardio-respiratory fitness and cardio-metabolic risk markers in normal-weight to moderately obese subjects. However, whether such a relationship exists in severely obese subjects is not known.

MATERIALS AND METHODS

Cardio-respiratory fitness was measured by bicycle spiroergometry in 308 severely obese women (all BMI>35 kg/m(2)). The following cardio-metabolic risk markers were assessed: Glycolized hemoglobin levels (HbA1c), fasting glucose, insulin, calculated HOMA index, triglycerides (TG), total, low-, high-density cholesterol (Chol, LDL; HDL), Chol/HDL-Ratio, and uric acid. Computed multiple stepwise linear regression models generally included age, weight and height as independent variables.

RESULTS

Multiple stepwise linear regression models indicated that peak but not aerobic threshold related cardio-respiratory fitness indices were independently of age, weight and height associated with several cardio-metabolic risk markers. Specifically, maximally achieved load (Watt-peak) explained 1.4% of the variance in glucose levels (beta= -0.13; p=0.04) and 2.8% of the variance in HbA1c levels (beta= -0.18; p=0.01), while maximally achieved O2-uptake explained 3.9% of the variance in TG levels (beta= -0.20, p=0.001).

CONCLUSION

Our data for the first time indicate that cardio-respiratory fitness is independently associated with cardio-metabolic risk markers in severely obese women.

Plicamycin and pamidronate in symptomatic tumor-related hypercalcemia: a prospective randomized crossover trial

We have conducted a randomized crossover comparative trial of a single-dose course of disodium (3-amino-1-hydroxypropylidene) bisphosphonate pentahydrate (pamidronate) and plicamycin in 48 patients with a first occurrence of tumor-related hypercalcemia. All patients had hypercalcaemia-associated symptoms and serum-calcium levels (corrected for total protein) greater than or equal to 2.80 mmol/l. Pamidronate and plicamycin were given concurrently with rehydration immediately after diagnosis of hypercalcaemia was made. Both agents lowered serum calcium levels significantly within 1 week, with 88% of the evaluable patients in the pamidronate group and 45% of those in the plicamycin group achieving normocalcemia (p less than 0.01). In the patients who received pamidronate, the duration of normocalcemia was longer (p less than 0.05) and there was a significant decrease in serum creatinine (p less than 0.05). Vomiting occurred in 8 of 22 evaluable patients (36%) who received plicamycin, but in none of 25 evaluable patients who received pamidronate (P less than 0.01). Phlebitis occurred at the infusion site in more of the pamidronate-treated patients (P less than 0.05). Hypocalcemia, which occurred in 8 of 25 evaluable patients (32%) in the pamidronate group and in 1 of 22 of those (5%) in the plicamycin group, was either clinically asymptomatic or mild, except in one pamidronate-treated patient. Overall, pamidronate was found to be more effective and better tolerated than plicamycin, thereby confirming results of previous studies that showed pamidronate to be an effective, simple, and safe agent for the relief of the morbidity associated with tumor-related hypercalcemia.

[Peak flow profile and expert testimony. The significance of peakflow self assessment for pneumological expert testimony]

Quantitative assessment of pulmonary obstructive diseases, such as asthma, may be difficult because of variability of obstruction. This is particularly true with regard to expert evidence pulmonary physicians deliver to insurances. Severity of obstruction, degree of impairment by an obstructive ventilatory defect, and temporal relationship of bronchial obstruction to exposure, may not be detected by physiological measurements in the pulmonary function laboratory. Much of the expert's opinion on these matters will depend on the credibility he assigns to the insured individual. The insured individual, in the other hand, has no other proof available than the description of his complaints, which puts him at a disadvantage. Serial peak flow measurements can be instrumental in clarifying such issues. They add an objective dimension to the case history. Six cases in which expert evidence was commissioned by insurances are described in detail, to exemplify how the thinking of the experts was modified by peak flow profiles. The greater usefulness of serial peak flow measurements in occupational asthma is emphasized and problems that may arise with peak flow measurements are discussed.