COPD is an integrated disease entity which comprises pulmonary emphysema and chronic bronchitis. Pink puffer, thin, dyspneic but without cyanosis was a typical phenotype of pulmonary emphysema. Blue bloater, fat, edematous and cyanotic was a typical phenotype of chronic bronchitis. Recent clinical guideline divides COPD into emphysema type and non-emphysema type. Non-emphysema type is similar to chronic bronchitis but they are not cyanotic nor edematous as was blue bloater since the era when antibiotics became widely used. In some cases, COPD becomes symptomatic more than ten years after they quit smoking.
Pulmonary function tests show obstructive dysfunction, namely difficulty in expiration while patients often complain difficulty in inspiration. This symptom can be explained by dynamic hyper-inflation during exercise and air trapping during rest. As the diaphragm becomes flat in COPD, neck accessory muscles are used to pullup the thoracic cage for inspiration. The lung compliance (Cl) is big in COPD so the sternocleidomastoid muscle which has long stroke is effective to expand the lung. The development of sternocleidomastoid muscle, i.e., visible dimple between sternal and clavicular attachment of the muscle implies that the patient's FEV1 ＜ 1 L.
In CPFE (combined pulmonary fibrosis and emphysema), the lung size and its overall Cl is almost normal. As the diaphragmatic curvature is preserved, its excursion is preserved. This is the cause of the scalene muscles, which are wider and have bigger torque than sternocleidomastoid muscle are the dominant neck accessory muscles used in CPFE. Understanding these pathophysiology helps learning of clinical history taking and physical examination.
Functional neuroimaging techniques, such as functional magnetic resonance imaging and voxel-based morphometry, are powerful tools in headache research and have greatly contributed to our understanding of pathophysiology of headache disorders. Over the past two decades, the brainstem and hypothalamus have been identified as target regions of interest in migraine and cluster headache pathophysiology. A number of functional neuroimaging studies have shown that migraine is associated with significant gray matter activation and/or reduction in several cortical areas involved in pain processing and modulation. Recent evidence suggests that the brainstem and hypothalamus activity periodically change during different stages of the migraine cycle. Additionally, the morphometric gray matter changes have been identified between ictal and interictal migraine phases.
Objectives: Measurement of flow-mediated vasodilation (FMD) in the brachial artery is widely used to assess endothelial function in humans. The diagnostic criteria for vascular failure based on FMD remain to be established, however. The purpose of this study was to establish diagnostic criteria for endothelial dysfunction based on FMD in the brachial artery.
Methods: Data were obtained from the Flow-mediated Dilation Japan Registry (FDR) and Flow-mediated Dilation Japan (FMD-J) studies, which included 6413 Japanese individuals with no history of cardiovascular disease to determine the cutoff value for normal endothelial function. Next, prospective studies investigating the association between FMD and cardiovascular events in individuals with no history of cardiovascular disease were overviewed to determine the cutoff value for endothelial dysfunction.
Results: Receiver-operating characteristic curve analysis of the data from the FDR and FMD-J studies revealed that the cutoff value with FMD in discriminating individuals aged 30－74 years and with from those with no cardiovascular risk factors was 6.9％ . This indicated that the cutoff value for normal endothelial function was approximately 7％. According to the results of four previous studies investigating the association between FMD and cardiovascular events in individuals with no history of cardiovascular disease, the cutoff values for patients at high risk for cardiovascular events ranged from between 2.9％ to 4.7％, indicating that the cutoff value for endothelial dysfunction was approximately 4％.
Conclusions: Based on these findings, the following criteria for brachial artery FMD-based diagnosis of vascular failure are proposed: ＜ 4.0％ for endothelial dysfunction; ≥ 4.0％ and ＜ 7.0％ for borderline; and ≥ 7.0％ for normal endothelial function.
Background: This study was designed to investigate the association between long-term systolic blood pressure (SBP) variability and the decline in the estimated glomerular filtration rate (eGFR).
Methods: The subjects included 303 males without renal dysfunction or dialysis treatment. SBP variability was defined as the standard deviation (SD) from their periodic health checkup data at seven consecutive visits.
Results: The eGFR decline was found to be significantly associated with an increase in the SD of SBP. In addition, the eGFR decline in the combined high SD of SBP and high average SBP group was significantly greater in comparison to other groups.
Conclusions: These results suggest that the longterm SBP elevation and its variability may be associated with the prevention of a decline in the renal function.