Category Archives: Physiology

Physiology

Ethylene transcriptionally regulates cold stress in grapevine leaves – Phys.org

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Low temperature can affect the development of plants and the yield of crops. Ethylene (ETH) is known to positively regulate cold tolerance. However, the role of ETH in transcriptional regulation of grapevine leaves subjected to low temperature stress remains poorly understood.

Researchers from the Wuhan Botanical Garden of the Chinese Academy of Sciences selected leaves of V. amurensis, a wild grape variety that is extremely cold-tolerant in winter, as experimental material. They investigated changes in the transcriptome and phytohormones of grapevine leaves under low temperature stress, identified genes regulated by ETH under low temperature stress and discussed possible interactions between ETH and other low temperature-induced phytohormones.

The researchers found that two highly enriched transcription factors families, APETALA2/ETHYLENE RESPONSIVE FACTOR (AP2/ERF) and WRKY, exhibited consistent up-regulation in response to cold stress, but inhibited by aminoethoxyvinylglycine (AVG, an inhibitor of ETH synthesis) treatment. The study was published in Plant Physiology and Biochemistry on March 10.

The inhibition of ETH synthesis (using AVG) enables the identification of genes positively and negatively regulated by ETH that participates in a wide range of biological processes, such as, solute transport, protein biosynthesis, phytohormone action, antioxidant and carbohydrate metabolism.

Beyond their potential roles in regulating many aspects of cellular metabolism, transcriptone and phytohormone analysis also indicates that ETH may regulate the abscisic acid (ABA) and indole-3-acetic acid (IAA) synthesis-related genes, thus contributing to respective phytohormone accumulation and potential downstream signals.

This work provides new insight into the ETH signaling pathways and ETH-regulated genes under cold stress, and presents candidate gene resource for breeding cold-resilient grapevines.

More information: Yujun Hou et al, Dissecting the effect of ethylene in the transcriptional regulation of chilling treatment in grapevine leaves, Plant Physiology and Biochemistry (2023). DOI: 10.1016/j.plaphy.2023.03.015

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Physiology

The Physical and Mental Benefits of Stretching Regularly – Laughing Squid

In a limberTED-Ed lessonwritten byMalachy McHugh and directed bySofia Pashaei,narratorAddison Anderson explains the physiology of stretching, how varied stretching is important for different exercises, how long and often stretching should be done, and how stretching is beneficial to both brain and body.

Typically, athletes stretch before physical activity to avoid injuries like muscle strains and tears. But does stretching actually prevent these issues?And if so, how long do the benefits of stretching last? To answer these questions, we need to know whats actually happening in the body when we stretch.

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The Physical and Mental Benefits of Stretching Regularly - Laughing Squid

Physiology

Middletown’s Libretti inducted into Biology Honor Society at Scranton – themonmouthjournaleastern.com

MIDDLETOWN Victoria Libretti of Middletown was among the 54 University of Scranton students inducted into Beta Beta Beta, the national honor society for biology. For induction into the honor society, students must have completed at least three biology courses, maintained at least a 3.0 grade point average in biology, and be in good academic standing at the University. The honor society encourages undergraduate biological research through presentations at conventions, publication in the journal BIOS, and research/travel grants. The University's chapter of the honor society was established in 1994.

Libretti is a sophomore physiology major at the Jesuit university located in Northeastern Pennsylvania.

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Middletown's Libretti inducted into Biology Honor Society at Scranton - themonmouthjournaleastern.com

Physiology

Physical therapist assistant students learn compassion as … – Pennsylvania State University

HAZLETON, Pa. Each year, students enrolled in the Clinical Reasoning for the PTA course in Penn State Hazletons Physical Therapist Assistant program head out into the community to volunteer their time for those in need. Each year, their experiences are the same.

The word we always hear is rewarding, said Gina Tarud, associate teaching professor of Physical Therapy and instructor for the course. Ive never had anyone who said they didnt enjoy it.

Madi Entz and Raven Van Gogh are no different. Both are in their final semester of the two-year PTA program and are among the PTA students enrolled in the course for spring 2023.

Each is part of a three-member group charged with helping others not with the physical skills theyve learned, but instead by utilizing their compassion, care, service, social responsibility and other qualities critical to a successful physical therapist assistant.

In the physical therapy profession, were very involved in community outreach, especially time spent volunteering, Tarud said. Part of our duty to the profession is getting students to realize that we play a role not just in helping people with physical ailments but getting out there and helping those in need in our communities as well.

Groups are given guidelines but largely have free reign over how they conduct their projects, including where they would like to volunteer. They spend about eight weeks working with their chosen organization.

Van Goghs group volunteers at AGAPE in Bloomsburg, a community organization that provides food, clothing, home goods and other essentials to people in need. His group helps log inventory and sort donations that come into AGAPEs 100,000-square-foot warehouse.

It was really awesome to be able to get out in the community and work with people, he said. It just makes you want to do more and more of it.

Entz and her group chose Brandons Forever Home, a nonprofit in Hazleton that offers services to children in foster care. Foster families can visit Brandons Forever Home to pick up food, clothing, toiletries, toys and more. Entz and her group also helped organize donations.

Its nice to experience a different way of helping people, Entz said. As PTAs, were getting them back to their normal lives physically, but this course gives us a chance to see the profession from a new perspective.

Tarud said she implemented the volunteerism aspect of the course into her curriculum about 13 years ago to give students the experience of working as part of a team.

These projects get them out there to experience being engaged in a community and working closely as a group, she said. It gets them to think on their own.

The PTA program has been offered at Penn State Hazleton for 40 years and has been accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE) since 1983. Its comprehensive curriculum offers general education courses and major course work in topics including anatomy, physiology, kinesiology, therapy procedures, rehabilitation, human musculature and functional anatomy, and professional issues in clinical practice.

Both students spoke highly of the program, particularly their experiences in clinical experiences. Students must complete clinical learning experiences in acute, outpatient and inpatient care, ensuring they are capable of treating patients of all ages in various situations.

I started off not wanting to go into inpatient care but now Im starting to think that might be something I want to try, Entz said. Having that experience helps me decide where I might want to have a job.

Tarud said students in the Physical Therapist Assistant and Rehabilitation and Human Services programs will work together on service projects beginning in spring 2024.

Entz, Van Gogh and the rest of the PTA students in the course will conduct presentations on their service projects on April 13 at 8 a.m. in Room 7E of the Physical Education Building.

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Physiology

Risk of ICU Admission and Related Mortality in Patients… : Critical … – LWW Journals

KEY POINTS

Questions: The efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors on clinical outcomes related to burden of critical illness has not been examined.

Findings: In this retrospective cohort study, 10,308 SGLT2 inhibitors users and 17,664 dipeptidyl peptidase-4 (DPP-4) inhibitors users were included in analysis after 1:2 propensity score matching. The use of SGLT2 inhibitors compared with DPP-4 inhibitors was significantly associated with lower rates of ICU admission (286 [2.8%] vs 645 [3.7%]) and all-cause mortality (315 [3.1%] vs 1,327 [7.5%]).

Meanings: SGLT2 inhibitors may be associated with benefits in clinical efficacy and cost-benefit ratios in the critical care setting that remains to be confirmed in prospective trials.

The global burden of critical illness has steadily increased especially with an aging population in the developed world (1). Despite modern advances in life support, mortality rates in the ICU has remained persistently high at over 15%, and even higher for patients admitted with sepsis (2,3). However, recent clinical trials have failed to identify therapies that effectively moderate overall ICU and sepsis-related mortality (4,5). In large cohort studies, patients with diabetes contribute more than 15% of intensive care admissions and are at increased risks of adverse outcomes after intensive care (6).

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce the occurrence rate of major adverse cardiovascular events (MACE) and adverse renal events among patients with type 2 diabetes in randomized controlled trials (711). At the same time, certain safety endpoints were more frequently observed in the groups assigned to SGLT2 inhibitors, including urinary tract infection, diabetic ketoacidosis (DKA), hypotension, volume depletion, and amputation (79,12). While there have been preliminary data on the reduced risks of pneumonia and sepsis-related morbidities with use of SGLT2 inhibitors (13,14), the effect on the overall burden of critical illnesses and their efficacy in reducing ICU-related mortality have not been studied.

The objective of the study was to determine whether SGLT2 inhibitors had any benefit to the overall burden of critical illness. We hypothesized that the use of SGLT2 inhibitors is associated with decreased risks of ICU admission and all-cause mortality. We compared the risks and causes of admission to the ICU, severity of illness, and mortality associated with the incidental use of SGLT2 inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors among patients with type 2 diabetes.

Data on new users of SGLT2 inhibitors or DPP-4 inhibitors between January 1, 2015, and December 31, 2019, from all public hospitals in Hong Kong were reviewed. Patients baseline characteristics, clinical information, and outcomes were retrieved from the Clinical Data and Analysis Reporting System of the Hospital Authority in Hong Kong. We included all adult patients (18 yr old or older) with type 2 diabetes who received SGLT2 inhibitors or DPP-4 inhibitors for the first time or had not received these drugs within 12 months prior to the index date. Type 2 diabetes was defined as having an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code starting with 250, except those indicating type 1 diabetes; or having baseline hemoglobin A1c (HbA1c) greater than or equal to 6.5%; or using any anti-diabetic medications (i.e., insulins, glucagon-like peptide-1 [GLP-1] agonists, or oral hypoglycemic agents). Patients who received SGLT2 inhibitors or DPP-4 inhibitors for other indications and did not have diabetes were not included. Exclusion criteria were patients with estimated glomerular filtration rate (eGFR) less than 25mL/min/1.73 m2 or patients who were started on both SGLT2 inhibitors and DPP-4 inhibitors on the index date. This study was approved by the Institutional Review Board of The University of Hong Kong/Hospital Authority of Hong Kong West Cluster with a waiver of informed consent on July 28, 2022 (Institutional Review Board reference number: UW 22-561, study title Association of SGLT2 Inhibitors and ICU Outcomes In a Territory Wide Longitudinal Cohort). All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration of 1975 and its later amendments.

We defined the index date as the first date of dispensing SGLT2 inhibitors or DPP-4 inhibitors. SGLT2 inhibitors included canagliflozin, dapagliflozin, and empagliflozin. DPP-4 inhibitors included alogliptin, linagliptin, linagliptin/metformin, saxagliptin, sitagliptin, sitagliptin/metformin, vildagliptin, and vildagliptin/metformin. Patients were assigned to either the SGLT2 inhibitors group or DPP-4 inhibitors group and followed up according to their assigned drug group. Patients who were prescribed medication from the alternative drug group were censored on the dispense date of the alternative drug.

The co-primary outcomes were any admission to the ICU and all-cause mortality. Secondary outcomes were duration of ICU stay, severity of illness upon ICU admission, mortality due to cardiovascular, renal, and infectious causes, any emergent ICU admission, and any nonoperative ICU admission. The severity of illness upon ICU admission was measured by the Acute Physiology and Chronic Health Evaluation (APACHE) IV-predicted mortality (15). Safety outcomes including DKA, lower limb amputation, new requirement for dialysis, acute pulmonary edema, and urinary tract infection were also examined. DKA was defined using ICD-9-CM code or an elevated beta-hydroxybutyrate level. All outcome events were recorded until the date of censoring or death, or the data cutoff date of March 31, 2022, whichever occurred first. Detailed ICD-9-CM codes for clinical outcomes are listed in eTable 1 (https://links.lww.com/CCM/H330).

Patients baseline characteristics including age, sex, HbA1c, eGFR, comorbidities, and previous ICU admissions were collected. Detailed ICD-9-CM codes for comorbidities, that is, malignancy, hypertension, cerebrovascular disease, coronary artery disease, and congestive heart failure (CHF) are listed in the eTable 1 (https://links.lww.com/CCM/H330). Concomitant cardiovascular medications, including aspirin, statins, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs); laboratory results were also obtained. Baseline laboratory results were defined as results closest to the index date.

All analyses were performed with prespecified outcome and statistical methods. Based on data in published literature and biological plausibility, we constructed a logistic regression model that predicted the likelihood of receiving SGLT2 inhibitors or DPP-4 inhibitors. These included age, sex, baseline HbA1c, duration of diabetes, eGFR, previous ICU admission, underlying malignancy, hypertension, cerebrovascular disease, coronary artery disease, CHF, use of metformin, insulins, sulfonylureas, GLP-1 agonists, thiazolidinedione, ACEIs or ARBs, beta-blockers, statins and ezetimibe, calendar year of index medication initiation, risk for amputation, risk for fractures, and risk for genitourinary infections. Risk for amputation was defined using history of peripheral vascular disease or lower limb amputation. Risk for fractures was defined using history of osteoporosis or fractures, and risk for genitourinary infections was defined using history of urinary tract infections or positive urine cultures. The final study cohort consisted of two comparison groupsSGLT2 inhibitors and DPP-4 inhibitorsgenerated by 1:2 propensity score matching using a caliper of 0.2 times sd of the logit of propensity score.

Unadjusted analyses were made using chi-square tests for categorical variables and Student t test or Wilcoxon rank-sum tests for continuous variables. Cox proportional hazards regression was performed to evaluate the relationship between use of SGLT2 inhibitors or DPP-4 inhibitors and clinical outcomes in a time-to-first-event analysis.

First, we performed sensitivity analysis by including all complete cases before propensity score matching. A multivariable Cox proportional hazards model adjusting for the same variables in the propensity score model was used to examine the association between study groups and the co-primary outcomes. Next, we repeated the analysis in all complete cases before propensity score matching using inverse probability treatment weighting to adjust for the same set of confounders. An on-treatment analysis was performed to account for possible differences in treatment duration.

Since the complete case method was adopted to address missing data in the primary statistical analysis, we tested the robustness of our results by repeating the multivariable Cox regression analysis with the entire cohort using the technique of multiple imputations by chained equations to account for missing data. We calculated E-values to quantify the association that a confounder would need to have with clinical outcomes to nullify the primary analyses (16). Finally, to better ensure that the observed association between medication groups and clinical outcomes was not due to some underlying cause unrelated to the mechanistic hypothesis, falsification testing was performed with two clinical outcomes, trauma and acute cholecystitis. These outcomes were selected based on unlikely causal relationships with the medication groups, and detailed ICD-9-CM codes are listed in eTable 1 (https://links.lww.com/CCM/H330).

Subgroup analyses were performed according to the following seven dichotomized subgroups: age greater than 65 years, sex, HbA1c greater than 8%, eGFR less than 60mL/min/1.73 m2, previous heart failure, number of oral hypoglycemic agents greater than or equal to 2, and index medication initiation during or after 2018.

All analyses were performed using Stata MP software, Version 16.1 (StataCorp, College Station, TX). A two-tailed p value of less than 0.05 was considered statistically significant.

Between January 2015 and December 2019, a total of 73,111 patients were considered for inclusion: 4,053 (5.5%) were excluded after application of exclusion criteria. Of the remaining 69,058 patients, a total of 6,674 (9.7%) were excluded from complete case analysis due to missing values in any of the variables used in the propensity score matching model. After 1:2 propensity score matching, a total of 10,308 SGLT2 inhibitors users and 17,664 DPP-4 inhibitors users were included in the final analysis, representing 44.8% of the complete case cohort (eFig. 1, https://links.lww.com/CCM/H330). The mean age of the cohort was 5911 years, and 17,416 (62.3%) were male. Baseline characteristics and medications prescribed of the propensity score matched cohort and the complete case cohort are shown in Table 1 and eTable 2 (https://links.lww.com/CCM/H330), respectively. All variables in Table 1 were included in the propensity score model, and apart from certain oral anti-diabetic agents were well-balanced between groups with standardized difference less than 0.1. The median follow-up period was 2.9 years (2.34.0 yr).

aLipid-lowering medications included atorvastatin, fluvastatin, rosuvastatin, simvastatin, and ezetimibe.

bRisk for amputation was defined using history of peripheral vascular disease or lower limb amputation.

cRisk for fractures was defined using history of osteoporosis or fractures.

dRisk for genitourinary infections was defined using history of urinary tract infections or positive urine cultures.

All results were presented with frequency (percentage) or mean sd.

Table 2 describes the primary and secondary outcomes in SGLT2 inhibitors users and DPP-4 inhibitors users. Critical illness requiring ICU admission occurred in 286 patients (2.8%) in the SGLT2 inhibitor group and 645 patients (3.7%) in the DPP-4 inhibitor group. The risk of ICU admission was lower in SGLT2 inhibitors users compared with DPP-4 inhibitors users (hazard ratio [HR], 0.79; 95% CI, 0.690.91; p = 0.001), translating to an absolute between-group difference of 0.9 percentage points (95% CI, 0.51.3) and a number needed to treat of 114. The severity of illness upon ICU admission was lower in SGLT2 inhibitors users compared with DPP-4 inhibitors users (median APACHE IV-predicted risk of death 0.08 [0.030.25] vs 0.14 [0.050.36]; p < 0.001). The ICU length of stay was similar between the two groups. The risk of emergency ICU admission was lower in SGLT2 inhibitors users (208 [2.0%] vs 496 [2.8%]; HR, 0.75; 95% CI, 0.640.89; p = 0.001), as was the risk of nonoperative ICU admission (151 [1.5%] vs 415 [2.4%]; HR, 0.66; 95% CI, 0.540.79; p < 0.001). Kaplan-Meier survival curves showed that the use of SGLT2 inhibitors was associated with lower risks of critical illness requiring any ICU admission, emergent ICU admission, and nonoperative ICU admission (Fig. 1). Admissions for sepsis were fewer in SGLT2 inhibitors users compared with DPP-4 inhibitors users (45 [0.4%] vs 134 [0.8%]; HR, 0.61; 95% CI, 0.430.85; p = 0.004). Data for other causes of ICU admission are presented in eTable 3 (https://links.lww.com/CCM/H330).

DPP-4 = dipeptidyl peptidase-4, SGLT2 = sodium-glucose cotransporter 2.

aResults are presented as rate per 100 patient year (95% CI).

bResults are presented as median (interquartile range).

cAmong 931 people required ICU admission, two patients (0.2%) had missing Acute Physiology and Chronic Health Evaluation IV predicted values, therefore, n = 929.

Estimated probabilities of ICU admission stratified by sodium-glucose cotransporter 2 (SGLT2) inhibitor group and dipeptidyl peptidase-4 (DPP-4) inhibitor group. Use of SGLT2 inhibitors was associated with lower risks of critical illness requiring any ICU admission (hazard ratio [HR], 0.79; 95% CI, 0.690.91; p = 0.001) (A), emergent ICU admission (HR, 0.75; 95% CI, 0.640.89; p = 0.001) (B), and nonoperative ICU admission (HR, 0.66; 95% CI, 0.540.79; p < 0.001) (C) compared with use of DPP-4 inhibitors.

The co-primary outcome of all-cause mortality occurred in 315 patients (3.1%) in the SGLT2 inhibitor group and 1,327 patients (7.5%) in the DPP-4 inhibitor group. The risk of death was lower in SGLT2 inhibitors users compared with DPP-4 inhibitors users (HR, 0.44; 95% CI, 0.380.49; p < 0.001), translating to an absolute between-group difference of 4.5 percentage points (95% CI, 3.95.0) and a number needed to treat of 22 (Table 2). The risk of mortality due to infectious causes was lower in SGLT2 inhibitors users compared with DPP-4 inhibitors users (59 [0.6%] vs 414 [2.3%]; HR, 0.26; 95% CI, 0.200.34; p < 0.001). The risk of cardiovascular death was lower in SGLT2 inhibitors users (105 [1.0%] vs 332 [1.9%]; HR, 0.58; 95% CI, 0.460.72; p < 0.001), as was the risk of renal-related mortality (3 [0.03%] vs 25 [0.14%]; HR, 0.22; 95% CI, 0.070.73; p = 0.014). Kaplan-Meier survival curves demonstrated that the use of SGLT2 inhibitors was associated with lower risks of all-cause mortality, mortality due to infectious, cardiovascular, and renal causes, compared with use of DPP-4 inhibitors (Fig. 2).

Estimated probabilities of all-cause mortality stratified by sodium-glucose cotransporter 2 (SGLT2) inhibitor group and dipeptidyl peptidase-4 (DPP-4) inhibitor group. Use of SGLT2 inhibitors was associated with lower risks of all-cause mortality (hazard ratio [HR], 0.44; 95% CI, 0.380.49; p < 0.001) (A), mortality due to infectious causes (HR, 0.26; 95% CI, 0.200.34; p < 0.001) (B), cardiovascular mortality (HR, 0.58; 95% CI, 0.460.72; p < 0.001) (C), and renal mortality (HR, 0.22; 95% CI, 0.070.73; p = 0.014) (D) compared with use of DPP-4 inhibitors.

After adjustment by multivariable Cox regression, the risk of ICU admission was lower in SGLT2 inhibitors users compared with DPP-4 inhibitors users (HR, 0.85; 95% CI, 0.740.97; p = 0.016) in the complete case cohort (n = 62,384), as was the risk of all-cause mortality (HR, 0.53; 95% CI, 0.470.60; p < 0.001), which were consistent with the primary analysis. These associations remained significant after adjustment by inverse probability treatment weighting as determined by the propensity score (ICU admission: HR, 0.76; 95% CI, 0.710.81; p < 0.001 and all-cause mortality: HR, 0.43; 95% CI, 0.410.45; p < 0.001). The median duration of treatment were similar in the two medication groups (SGLT2 inhibitors: 953 d [4031,367 d] and DPP-4 inhibitors: 967 d [4001,351 d]; p = 0.70), and results in the on-treatment analysis were similar to the intention-to-treat analysis.

A total of two variables, baseline HbA1c and eGFR, in the propensity score model had missing data. Multiple imputation was conducted, and the imputed cohort included all 6,674 patients (9.7%) who were excluded due to missing values in any of the variables used in the propensity score model. The association between SGLT2 inhibitors and ICU admission in the imputed dataset remained significant (adjusted HR, 0.79; 95% CI, 0.69 to 0.90; p < 0.001), as was the association with all-cause mortality (adjusted HR, 0.52; 95% CI, 0.460.58; p < 0.001). The E-value for the HR for new ICU admission is 1.63, while the E-value for the HR for all-cause mortality is 2.94, suggesting that for an unmeasured confounder to render the primary results statistically insignificant, it would need to be very strongly associated with ICU admission and all-cause mortality (> 60% difference in prevalence between SGLT2 inhibitors users and DPP-4 inhibitors users, and a HR > 1.6 or < 0.6 on ICU admission). Finally, falsification testing showed that the clinical outcomes of trauma and acute cholecystitis were not significantly associated with medication group. Detailed results of sensitivity analyses are presented in Table 2.

The effect of SGLT2 inhibitors on the outcomes of ICU admission and all-cause mortality was modified by eGFR (p for interaction < 0.001 and 0.004, respectively), with patients with eGFR less than 60mL/min/1.73 m2 deriving more clinical benefit than those with eGFR greater than or equal to 60mL/min/1.73 m2. The benefit of SGLT2 inhibitors on ICU admission was greater in patients on less than two oral hypoglycemic agents (p for interaction = 0.042) and the benefit of SGLT2 inhibitors on all-cause mortality was greater in patients who were initiated on index medication before 2018 (p for interaction = 0.025). The associations between SGLT2 inhibitors and outcomes were not modified by age, sex, HbA1c level, or previous CHF (p for interaction > 0.05 for all) (eTable 4, https://links.lww.com/CCM/H330; and Fig. 3).

Forest plots for subgroups analyses. The effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the outcomes of ICU admission and all-cause mortality was modified by estimated glomerular filtration rate (eGFR) (p for interaction < 0.001 and 0.004, respectively). Patients who were on less than two oral hypoglycemic agents and patients who were initiated on index medication before 2018 also derived greater clinical benefit. There was no effect modification in other predefined subgroups for the two co-primary outcomescritical illness requiring any ICU admission (A) and all-cause mortality (B). DDP4i = dipeptidyl peptidase-4 inhibitor, HbA1c = hemoglobin A1c.

Safety outcomes are reported in Table 3. The risks of lower limb amputation, new requirement for dialysis, acute pulmonary edema, and urinary tract infection were significantly lower in SGLT2 inhibitors users compared with DPP-4 inhibitors users (p < 0.05 for all). The risk of DKA was similar between the SGLT2 inhibitor users and DPP-4 inhibitor users (160 [1.6%] vs 297 [1.7%]; p = 0.41).

aDiabetic ketoacidosis was defined as using International Classification of Diseases, 9th Revision, Clinical Modification code or an elevated beta-hydroxybutyrate level.

bNew requirement for dialysis refers to patients who were started and maintained on dialysis with no record of receiving dialysis prior to the index date.

In this cohort of 69,058 adult patients with type 2 diabetes, initiation of SGLT2 inhibitors compared with DPP-4 inhibitors were associated with lower risks of critical illness, decreased disease severity, and lower all-cause mortality over a median follow-up of 2.9 years. We identified that infections- and sepsis-related admissions to ICU and mortality were concurrently mitigated by the use of SGLT2 inhibitors. The beneficial effects of SGLT2 inhibitors were seen across various subgroups of age and underlying comorbid conditions, and the protection appeared to be more pronounced in patients with chronic renal impairment.

SGLT2 inhibitors have been shown to effectively reduce MACE and renal events among patients with type 2 diabetes (710). Since hospitalizations secondary to decompensated heart failure and decline in renal function are clearly reduced with the use of SGLT2 inhibitors, it would be reasonable to extrapolate a reduction in burden of critical illnesses and admissions to ICU. However, SGLT2 inhibitors have been associated with a two- to 10-fold risk of DKA (8,17), along with other safety concerns including a doubling in risk of severe urinary tract infection (18), hospital admission for infections (19), volume depletion (8,20), hypotension (21), or even amputation (9). Taken together, the net effect of SGLT2 inhibitors on critical illness and the utilization of ICU resources remains to be clarified. To our knowledge, this topic has never been evaluated in any randomized trials or observational studies.

In the current study including a large representative cohort of patients with type 2 diabetes, we observed that the risk of critical illness requiring admission to ICU was reduced by approximately 20% with the use of SGLT2 inhibitors. The biological mechanisms underlying the protective effects of SGLT2 inhibitors against critical illnesses are multidimensional, among which benefits in cardiac and renal function are two of the most important. SGLT2 inhibitors can improve cell life programming (22), arterial stiffness (23), cardiac structure and function (24,25), and reduce cardiorenal effects and albuminuria (26,27); hence, the strong cardiorenal efficacy observed in clinical trials (28). In our cohort, the absolute differences in mortality due to cardiovascular and renal causes were 0.9% and 0.1%, respectively.

More specific to acute and critical illnesses, SGLT2 inhibitors have been associated with protective effects against pneumonia, sepsis, and infection-related mortality (13). This may be related to the anti-inflammatory properties of SGLT2 inhibitors, mediated through down-regulation of cytokine production by macrophages and inflammasomes (29). Alternative mechanisms such as counteracting lipopolysaccharide (LPS)-induced vascular hyperpermeability and improving intestinal barrier function have also been demonstrated in animal models (30,31). The beneficial effects of SGLT2 inhibitors were observed across all categories of ICU admission but were most evident in reducing nonoperative ICU admissions, which in our cohort referred to emergency admissions due to nonsurgical causes. When further stratified by disease category, the reduction in ICU admission due to sepsis was the most striking, with a 40% reduction in risk for SGLT2 inhibitors users. The milder severity of illness upon ICU admission may be partially explained by pathophysiological mechanisms such as damping of LPS-induced acute renal injury in animal models (14), possibly undermining the greater benefit derived in patients with renal impairment and eGFR less than 60mL/min/1.73 m2. The reduction of sepsis-related complications in chronic users of SGLT2 inhibitors, if confirmed in follow-up prospective trials, could have significant implications for the population with diabetes, to whom up to 6% of infection-related hospitalizations and 12% of infection-related deaths had been attributed (32). It remains to be examined whether users of SGLT2 inhibitors for reasons other than diabetes would derive similar clinical benefits.

The significant reduction in all-cause mortality of SGLT2 inhibitors that has been demonstrated in randomized trials was further validated in our cohort (9,11), as were reductions in death due to cardiovascular, renal, and infection-related causes, with a number needed to treat of 22. Recent studies have shown that the clinical benefit derived from SGLT2 inhibitors begins to manifest as early as 13 days (33). The potential cost-efficiency of SGLT2 inhibitors in decreasing healthcare utilization and morbidities across broad populations of patients with cardiovascular risk factors, risks for progressive renal injury, and even immunosuppressed or infection-prone individuals could amount to significant cost-benefit ratios across hospital intensive care systems (34).

The current study had some limitations. First, the observational nature of the study conferred risks of unmeasured confounding and bias, but the large cohort size with complete longitudinal electronic healthcare records and incident new user design minimized selection, information, and recall biases (35). We used rigorous propensity score matching, and the findings were consistent in many sensitivity analyses. The utilization of an active comparator of DPP-4 inhibitors allowed evaluation of SGLT2 inhibitors in a typical decision bifurcation during escalation of diabetes care. Second, we only collected prescription data and could not ascertain drug adherence, which could have biased the results toward the null. Third, patients were censored if they crossed over to or added on the other drug class, and the effect of continuing both drug classes is unclear.

In conclusion, we showed that patients with type 2 diabetes who were on SGLT2 inhibitors were independently associated with reduction in admission to the ICU, milder disease severity, and lower all-cause mortality compared with patients on DPP-4 inhibitors. The use of SGLT2 inhibitors in the critical care setting remains to be clarified in future prospective trials.

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Risk of ICU Admission and Related Mortality in Patients... : Critical ... - LWW Journals

Physiology

Phi Beta Kappa Selects New Members at UW | News – University of Wyoming News

April 7, 2023

The Alpha Chapter of Wyoming at the University of Wyoming has selected 36 new members for the prestigious Phi Beta Kappa honor society. Among the new inductees are four juniors who have been awarded $1,000 scholarships for their academic achievements.

Each year, 290 national chapters select new members into Phi Beta Kappa. Fewer than 1 percent of U.S. college graduates are chosen. Members have included 17 U.S. presidents and 42 U.S. Supreme Court justices. There are nearly 100 faculty and staff resident members in UWs chapter. The students who are selected for this honor at UW are usually in the top 3 to 4 percent of their classes.

A committee of Phi Beta Kappa members selects the eligible students based on liberal arts hours, foreign language hours and GPA, says Joy Landeira, professor, chair of the Department of Modern and Classical Languages and Alpha Chapter president. Phi Beta Kappa is one of the most respected honor societies in the United States.

The four juniors who have earned the Louise A. Lee Johnson Memorial Scholarships, listed by hometown, are:

Casper -- Joenon Sulzen, a Kelly Walsh High School graduate, who is studying English with honors and creative writing minors; and Samantha Veauthier, also a graduate of Kelly Walsh High School, who is studying zoology with an honors minor.

Cheyenne -- Dillon McLean, a graduate of Cheyenne Central High School, who is studying chemistry.

Diamond Point, N.Y. -- Morgan Miller, who is studying international studies with an honors minor.

The induction ceremony for the new members will take place Friday, April 28, at 4 p.m. in Room 506 of Coe Library. The event will be attended by family, friends and faculty members.

In addition to the scholarship recipients, 26 new seniors and six December graduates also have been elected to Phi Beta Kappa. Those newly elected members, listed by hometowns and majors, are:

Arvada, Colo. -- Madison Singh, gender and womens studies.

Bandera, Texas -- Kyla Ditges, English.

Boise, Idaho -- Larissa Rutz, history.

Broomfield, Colo. -- Elena Rae Stewart, English.

Casper -- Benjamin Radosevich, a Natrona County High School graduate, molecular biology.

Chattanooga, Tenn. -- Abby Worlen, B.A. in English (December 2022).

Cheyenne -- Val Herd Jr., a Cheyenne Central High School graduate, history; Christopher Hood, also a Cheyenne Central graduate, international studies and French; Maeve Knepper, a Cheyenne East High School graduate, economics and international studies; and Fox Glenn Nelson, also a Cheyenne East graduate, anthropology.

Douglas -- William Trimnal, a Douglas High School graduate, international studies.

Eagle River, Alaska -- Ashton Love, political science.

Fort Collins, Colo. -- Kaytlyn Vander Meer, chemical engineering and Spanish; and Frank Richard Wright, geography, and environment and natural resources with minors in Spanish and honors.

Gering, Neb. -- Brock Parker, astronomy and astrophysics.

Jackson -- Samantha Smith, a Jackson Hole High School graduate, B.A. in criminal justice, sociology and English (December 2022).

Lakewood, Colo. -- Lydia Ellefsen, environmental systems science, and environment and natural resources.

Lander -- Emma Jo Comstock, a Lander Valley High School graduate, B.A. in history (December 2022).

Laramie -- Hailey Hysong, a Laramie High School graduate, international studies; Sai Kit Ng, also a Laramie High graduate, microbiology and molecular biology with minors in music and physiology; and Lander Stone, also a Laramie High graduate, environmental systems science and religious studies.

McLean, Va. -- Anna Spear, environmental studies and environmental politics.

Midvale, Utah -- Shannon Fassler, English, and art and art history.

Monument, Colo. -- Makayla Kocher, English with minors in anthropology and museum studies.

Norway -- Irja Smith Sandvik, anthropology, and environment and natural resources.

Parker, Colo. -- Mckenna Egolf, history.

Phoenix, Ariz. -- Rebecca DeCero, history.

Pine Bluffs -- Harper Pachel, a Pine Bluffs High School graduate, B.A. in history (December 2022).

Powell -- Abigail Saville, a Powell High School graduate, B.S. in biology (December 2022).

Reno, Nev. -- Erin Schwalbe, microbiology.

St. Joseph, Mo. -- Ruby Jenco, environment and natural resources, and wildlife biology and management.

Torrington -- Maryssa Lira, a Torrington High School graduate, B.S. in microbiology (December 2022).

The Alpha Chapter of Wyoming was established in 1940. It sponsors lectures, scholarships and other academic activities. For more information about the Phi Beta Kappa honor society or UWs Alpha Chapter, visit http://www.uwyo.edu/pbk.

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Phi Beta Kappa Selects New Members at UW | News - University of Wyoming News

Physiology

National award honors UB biochemist’s transformational leadership promoting inclusivity in science – UBNow: News and views for UB faculty and staff -…

Campus News

UB biochemist Gabriela K. Popescuis an internationally known researcher in neuroscience and an effective advocate for making science a more welcoming and inclusive environment. Photo: Douglas Levere

By ELLEN GOLDBAUM

Published October 11, 2022

UB biochemist Gabriela K. Popescuis an internationally known researcher in neuroscience. She is also an effective advocate for making science a more welcoming and inclusive environment, efforts that have earned her a significant new honor.

The Society of General Physiologists (SGP) has chosen Popescu, professor of biochemistry in the Jacobs School of Medicine and Biomedical Sciences at UB, to receive the 2022 Sharona Gordon Award.

Established in 2020, the award recognizes individuals who have demonstrated transformational leadership in physiology and related fields. It is given to an individual who has made a clear and sustained impact on improving equity and inclusivity in the fields of physiology and biophysics.

Popescu will give an invited talk at the next SGP Awards Symposium.

The awards previous two winners are Karen Fleming, professor of biophysics at Johns Hopkins University, and Miriam Goodman, the Mrs. George Winzer Professor of Cell Biology at Stanford University.

Dr. Popescus achievements as an outstanding neuroscientist and as an advocate for equity in all aspects of the scientific endeavor are so deserving of this recognition, said Allison Brashear, MD, vice president for health sciences and dean of the Jacobs School. We could not be more proud that she is among the first scientists to be recognized with this impactful award.

The SGP states that Popescu led the charge to establish the Biophysical Societys anti-harassment code of conduct and organized its first plenary session addressing sexual harassment. The description adds: She continues to provide a voice in situations where implicit bias and unrealized inequities enter the room, particularly speaking up for those with invisible disabilities and raising awareness aboutviolence against women.

As a woman and an immigrant, Popescus awareness of the impact of inequities in science has evolved over the years, often as a direct result of the national scientific and educational organizations in which she has played increasingly influential roles.

Earlier this year, she was voted president-elect of the Biophysical Society, an international organization with 7,500 members. She previously served two terms as chair of that societys Committee for Professional Opportunities for Women.

A turning point

A key turning point for Popescu occurred in 2018. She was attending the leadership committee meeting of a national professional society when the National Academies of Sciences, Engineering and Medicine announced release of the report of its Committee on the Impacts of Sexual Harassment in Academia.

Together, attendees heard the news that the report had found that 50% of females in academic medicine reported having experienced some type of sexual harassment. At first, Popescu recalled, the room just went uncomfortably quiet. About a third of the people in the meeting were women. The first person to speak was a man. He said he wanted to see the data.

Then a woman who said she had been a Title IX officer spoke up. This woman said that sure, it would be good to see the data, but she thought 50% sounded accurate. Another woman mentioned that many instances of sexual harassment never even get reported.

As the conversation continued, Popescu could see peoples perceptions were beginning to change.

That report changed the playing field, Popescu said. And that was such a lesson for me. You have to be at the table.

Since then, Popescus willingness to speak up for people who are underrepresented in science has intensified. She initially served on the Administrative Board of the Association of American Medical Colleges Council of Faculty and Academic Societies (CFAS), representing the Jacobs School. In 2017, she was named chair-elect of CFAS, which also gave her a seat on the board of directors of the AAMC. She has used her participation on the boards of major organizations to raise awareness and make change.

I thought, what can I do? said Popescu, about how she thought she could make the most impact. I want to keep their feet to the fire.

First-ever plenaries on sexual harassment

She was instrumental in getting two major academic, scientific organizations CFAS and the Biophysical Society to hold their first-ever plenary sessions on sexual harassment, activities that the SGP cited in giving Popescu the Gordon award.

She is also serving her second term on the steering committee of the American Association for the Advancement of Science, which nominates AAAS fellows.

Popescu has also, not surprisingly, worked to benefit faculty at the Jacobs School. In 2018-19, with her colleagues, she started a program called SheLeads@Jacobs School, a yearlong curriculum designed to grow the pool of women faculty ready for leadership positions in academic medicine.

Early passion for making improvements

Her passion for improving conditions for her fellow scientists began early; she thinks it goes back to when she got her first grant after serving as a postdoctoral fellow in the Jacobs School in the lab of Anthony Auerbach, professor in the Department of Physiology and Biophysics.

He encouraged me to apply to the National Institutes of Health for something very prestigious: the F32 Ruth L. Kirschstein Postdoctoral Individual National Research Service Award, she recalled. And I got the grant. Its a big deal.

But at the same time she was celebrating that award, she discovered that it would mean that she would lose her health insurance.

The timing wasnt ideal. Popescu was raising two children and her daughter, who was 15, needed braces. She needed to figure out how to get back on insurance.

I thought, Ok, this is wrong. So I asked around and found out there wasnt even a postdoctoral association here. There was nobody responsible for postdocs, she said.

Popescu approached Suzanne Laychock, senior associate dean for faculty affairs, who agreed that it was a problem that needed addressing.

So we got some people together and organized a committee to evaluate how we could develop an association for postdocs. We thought we should at least have a door with a sign on it that says Postdoctoral office with someone in that office, said Popescu.

Their efforts paid off and resulted in what is now the Office of Postdoctoral Scholars.

Popescu noted, That was my first advocacy role in my career. It was figuring out what we needed. It was egregious to have nothing.

Participating in these activities helps magnify impact, Popescu said. What makes someone be impactful? she asked. Im there when the policies are being written, when the speakers are being invited and when fellows are being nominated. I am at the table, she said, adding with a grin: You know what they say: If youre not at the table, you are on the menu!

She has simple advice to young faculty interested in leadership roles. Everybody has their thing, she said. Do what youre passionate about. You see a wrong? Go right it. Its the right thing to do.

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National award honors UB biochemist's transformational leadership promoting inclusivity in science - UBNow: News and views for UB faculty and staff -...

Physiology

These are the real benefits of running, according to the science – Livescience.com

A runners body can come in all shapes and sizes, but the benefits of running remain the same for everyone. So, if youre thinking about kicking your run to the curb side now the weather has turned. dont!

Whether you stick with your outdoor run and yield the extra benefits of training in colder temperatures, or start looking into the best treadmill (opens in new tab) you can buy, studies show that in the long-term, running can improve longevity of life by lowering your blood pressure, cholesterol levels and resting heart rate. But theres more. For those who really want to deep-dive into the physiological technicalities, heres why running really is one of the best forms of exercise.

The term feel the burn is generally associated with hard working muscles during a workout. Youve probably felt it during a particularly gruelling session. Your body breaks down glucose to be used as energy and a by-product of this process is lactic acid. The harder you work, the more lactate accumulates until eventually you cant get rid of it quick enough.

This is known as your lactate threshold and there have been lots of studies - such as this one, published in the Journal of Physiology (opens in new tab) - that show the importance and role of anaerobic threshold in endurance sports.

A higher lactate threshold (aka anaerobic threshold) will allow for a faster, more sustainable running pace, says Jim Pate, Senior Physiologist at Marylebone Health (opens in new tab).

Jim Pate

Jim Pate is the senior physiologist and lab manager at the Centre for Health and Human Performance (CHHP). He specializes in cardiopulmonary exercise testing and heads up all of CHHPs exercise physiology services. He also lectures at UCL, as well as carrying out research at the university. Before joining CHHP, Jim not only worked in the NHS but also spent some time working at Everest Base Camp on the Extreme Everest Expedition, looking at how extreme conditions affect performance, survival and longevity.

When running at lower intensities, the primary component the body needs and uses to produce the energy is oxygen. This aerobic process is efficient but also relatively complex and can become overloaded or backed up, as energy demand rises with exercise intensity.

There will be a point where a second energy production system begins to make a contribution and this is the anaerobic system. This system produces energy rapidly without oxygen, but it is also inefficient, burning cellular fuel more quickly and producing the by-products: lactate and lactic acid.

From a running performance point of view, the shift to inefficient energy production results in an unsustainable system that will ultimately lead to fatigue. However, a higher lactate threshold is trainable and the best way to improve it is to train at, or around, lactate threshold intensity with working intervals significantly longer than recovery intervals.

Put simply, VO max is the maximum (max) rate (V) of oxygen (O) your body is able to consume and use during one minute of exercise. A higher VO max means youre in good shape physically and if youre looking to improve yours, running can help.

It has been shown that running at specific intensities for certain periods of time can actually improve your VO max, says Jonny Kibble, head of exercise and physical activity at Vitality (opens in new tab).

Johnny Kibble

Johnny Kibble is an experienced health and well-being coach, with a background in sports science. He currently works with Vitality, a UK health insurance company, where he leads physical activity workshops. In his spare time, he competes in 5ks, 10ks, triathlons and half marathons.

VO max is measured in millilitres of oxygen per kilogram of bodyweight per minute ml/kg/min. It is generally considered the gold standard measure of cardiovascular fitness the higher it is, the longer you can potentially exercise for, at any given intensity.

While it can be impacted by numerous genetic factors, such as age and sex (men will generally have a higher VO max than women due to muscle mass and haemoglobin levels), the good news is, everyone can improve theirs.

Research from the Medicine & Science in Sports and Exercise Journal (opens in new tab) shows that running at 90-95% of maximum heart rate for four minutes followed by four minutes of resting at 70% max heart rate, four times round (for a specific time period) increased participants VO max by an average of 7.2 per cent (2).

According to Kibble, on top of improving your running performance, a high VO max could also make everyday tasks easier to perform.

Another study in the Medicine & Science in Sports and Exercise Journal (opens in new tab) showed that climbing a set of stairs can cost around 33.5ml/kg/min of our VO max, which could be a sedentary individuals maximal capacity (27 - 40ml/kg/min), he explains. By improving this, it means we may find it easier to perform everyday tasks, which is particularly important as we grow older due to our VO max levels declining with age.

VO max can also play a huge part in prevention and, according to research from Frontiers in Bioscience (opens in new tab), is the strongest independent predictor of future life expectancy in both healthy and cardio-respiratory diseased individuals.

Lacing up and pounding the pavement can often be thought of as detrimental to joints and knees. However, research shows that running can in fact, be good for bone health.

Running is often perceived as bad for joints, in particular the knees and hips, and too much high impact exercise can damage bone and may cause long-term problems such as stress fractures, says Lindsy Kass, Principal Lecturer in Sport, Health and Exercise at the University of Hertfordshire (opens in new tab).

Kass is a Principal Lecturer on the BSc (Hons) Sport and Exercise Degree Programme at the University of Hertfordshire. She is a Registered Nutritionist and an Accredited Exercise Physiologist with the British Association of Sport and Exercise Science. Kass has worked at the University of Hertfordshire for over 15 years and is a Fellow of the Teaching and Learning Academy. Her work includes research into carbohydrate and protein sport drinks, looking at the effect of magnesium supplementation on blood pressure and exercise and, most recently, she was the lead investigator on a large study looking at the effect of the Covid lockdown on exercise and eating habits.

However, there is much evidence (opens in new tab) to show that impact exercise such as running can actually help with bone formation and bone density, and reduce the effect of osteoporosis. In one study published in the Journal of Exercise Rehabilitation (opens in new tab), long-distance runners were evaluated to establish change in bone properties using ultrasound and biochemical markers, to determine bone strength and bone formation markers. The male and female runners, aged 30-49 years ran an average of 48.6km per week, with an average frequency of 4.4 times per week. No significant difference was found in bone strength for either the males or females across all age groups meaning there was no decrement in bone strength when running long distances.

However, there was a significant improvement in blood serum markers of osteocalcin, which is a marker of bone formation, for both males and females across all age groups. This shows that bone formation may be improved with distance running, by stimulating osteoclasts. This supports the view that bone density is reliant on the forces acting on the bone in this case, the impact to the legs from running.

For those over 50, worried about osteoporosis, dont even think about switching to a non-resistance training modality. Research in the journal Osteoporosis International (opens in new tab) found that older runners had higher bone mineral density than swimmers of the same age. This suggests that moderate impact activities are better for maintaining skeletal integrity with age.

Struggling with that afternoon deadline? Cant make an important life decision? The answer might lie in a quick run.

A study by the University of Tsukuba in Japan (opens in new tab) last year showed that ten minutes of moderate-intensity running increases local blood flow to the parts of the brain that plays an important role in controlling mood and executive functions, says Elisabeth Philipps, a Clinical Neuroscientist and spokesperson for supplement brand FourFive (opens in new tab).

Elisabeth Philipps

Elisabeth Philipps is a clinical neuroscientist specializing in the endocannabinoid system. She has authored many articles on CBD, clinical neuroscience and health. One of her main strengths is being able to translate complex and dense scientific research into accessible written and presented content.

In such a short time, to see a mental improvement in brain function is really positive and should help spur people to enjoy daily exercise however long they have.

In the study, researchers found that just a short session increased blood flow to the prefrontal cortex so it could benefit everything from focus, memory, planning, organization, and even impulse decision making.

So, what does this mean in real life? Moderate intensity running can be worked out using fancy heart rate monitoring, but more simply you can do the talk test which for moderate intensity means you can comfortably talk whilst running at a pace for 10 minutes, she adds.

This might take a bit of training and working up to this level but even just getting moving and brisk walking, especially with some hills or inclines involved helps into improve brain blood flow and boost your happy hormones, as well as trigger endocannabinoid synthesis which releases bliss molecule anandamide to help you feel good. Running and walking outdoors is best - fresh air and nature really boosts mental health. In fact, the runner's high is not an endorphins release, as previously thought but the body releasing anandamide, an endocannabinoid produced in the body, which makes us feel great.

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These are the real benefits of running, according to the science - Livescience.com

Physiology

Are Cold Showers Healthier Than Hot Ones? Science Is Weighing In! – Twisted Sifter

Even if all of the scientists in the world were able to agree that a cold shower was better for your health, Im not sure all that many people would make the switch after all, theres just something nice about a nice, warm spray, right?

If youre curious what the answer is and why, though, just keep reading.

First off, lets talk about the different ways hot and cold showers affect our bodies.

According to an analysis presented at the 2018 Joint International Conference on Water Distribution System Analysis and Computing and Control for the Water Industry, most people prefer hot showers specifically, showers between the temperatures of 104 and 106 degrees F.

Hot showers are obviously nicer and more relaxing, and numerous studies have shown that showering before bed can help us sleep better by relieving body tension and stress. In addition, the hot water relieves muscle fatigue and may even lessen the pain associated with long-term conditions like osteoarthritis.

The bodys blood vessels expand when exposed to heat, which means immersion in warm water can improve arterial stiffness and improve circulation, even improving blood flow among people with chronic heart failure.

That said, dermatologist Sejal Shah reminds us that hot showers are not all good.

Hot water strips the skin of its natural oils leading to dry, itchy skin and eventually eczema. Similarly, hot water can strip the hair of its natural oils, causing it to be drier.

And that ability to lower blood pressure? Dr. Hassan Makki says its not a positive for everyone.

I must have heard a similar story at least a dozen times; a person is taking a hot shower, feels lightheaded and wakes up in a pool of blood from a head injury.

Hot showers, it turns out, are a prime place for those events called vasovagal syncopes to happen.

The heat has already caused a lot of the blood to be shifted to the superficial tissues (a mechanism the body uses to cool down). With less blood available in the tank so to speak, even a slight dip in blood pressure can cause syncope.

On the opposite end of the spectrum, cold showers have a reputation for being good for calming untoward urgesand there is some scientific data to support the claim that theyre good for your health.

There are several studies that point to an immune-boosting effect, which may or may not have something to do with the sympathetic nervous systemwhich is connected to our fight-or-flight reflex.

Lindsay Bottoms, a Reader in Exercise and Health Physiology at the University of Hertfordshire, explained more in The Conversation.

When this is activated, such as during a cold shower, you get an increase in the hormone noradrenaline. This is what most likely causes the increase in heart rate and blood pressure observed when people are immersed in cold water, and is linked to the suggested health improvements.

Cold showers also improve circulation, but when the water stops and your body has to work harder to warm itself back up.

Which is also why cold showers can help increase your metabolism. Some believe this, along with the idea that brown fat is activated by cold temperatures and stored around the shoulders and neck, also has some believing cold showers could promote weight loss.

Bottoms also explained that some are positive cold showers have mental benefits as well.

There is a school of thought that cold water immersion causes increased mental alertness. A cold shower may also help relieve symptoms of depression. A proposed mechanism is that, due to the high density of cold receptors in the skin, a cold shower sends an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which may have an anti-depressive effect.

Health and water expert Glen Coulson warns that there are also drawbacks.

Submerging in freezing cold water could cause the body to go into cold-water shock. That could cause a number of reactions, from hyperventilation to heart attacks.

So, should you take a hot shower or a cold one, if improving your health is your ultimate goal?

The best answer, says dermatologist Carl Thornfeldt, is somewhere in the middle.

The best solution is to take a warm, tepid shower and then finish off with cold rinse for the last few seconds to still reap the rewards of the cold water.

You definitely dont want to take a cold shower if youre coming in from a super hot day, because your body is working hard to stabilize its temperature on its own and the cold water will just throw it off.

It is always recommended to have a lukewarm shower rather than indulging a cold one.

I dont know about you, but they dont have to tell me twice.

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Are Cold Showers Healthier Than Hot Ones? Science Is Weighing In! - Twisted Sifter

Physiology

Cardiovascular physiology-changes with aging – PubMed

With aging there are changes in the cardiovascular system, which result in alterations in cardiovascular physiology. The changes in cardiovascular physiology must be differentiated from the effects of pathology, such as coronary artery disease, that occur with increasing frequency as age increases. The changes with age occur in everyone but not necessarily at the same rate, therefore accounting for the difference seen in some people between chronologic age and physiologic age. The changes in the cardiovascular system associated with aging are a decrease in elasticity and an increase in stiffness of the arterial system. This results in increased afterload on the left ventricle, an increase in systolic blood pressure, and left ventricular hypertrophy, as well as other changes in the left ventricular wall that prolong relaxation of the left ventricle in diastole. There is a dropout of atrial pacemaker cells resulting in a decrease in intrinsic heart rate. With fibrosis of the cardiac skeleton there is calcification at the base of the aortic valve and damage to the His bundle as it perforates the right fibrous trigone. Finally there is decreased responsiveness to beta adrenergic receptor stimulation, a decreased reactivity to baroreceptors and chemoreceptors, and an increase in circulating catecholamines. These changes set the stage for isolated systolic hypertension, diastolic dysfunction and heart failure, atrioventricular conduction defects, and aortic valve calcification, all diseases seen in the elderly.

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Cardiovascular physiology-changes with aging - PubMed