<i>Background</i>. The effects of clinical depression after orthotopic heart transplantation (OHT) are relatively unknown. The purpose of this study was to evaluate the impact of depression on outcomes after OHT. <i>Methods</i>. We performed a single center retrospective review of 102 consecutive patients who underwent OHT at Northwestern Memorial Hospital from June 2005 to October 2009. The diagnosis of depression was obtained from attending physician documentation. The primary endpoints were all-cause mortality (ACM), hospitalizations, and rejection. <i>Results</i>. Of 102 OHT patients, 26 (26%) had depression. Depressed patients were similar in age to nondepressed patients (57.6 years versus 56.9, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M1" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.21094" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.0135,0,0,-0.0135,39.985,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g></svg>). There was no statistical difference in survival between groups at 5 years after OHT (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M2" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.21094" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-58"/></g><g transform="matrix(.0135,0,0,-0.0135,39.984,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g></svg>). All-cause hospitalizations were higher in depressed versus nondepressed patients (4.3 versus 2.6 hospitalizations <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M3" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.7259 9.21094" width="46.7259pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg>). There were no significant differences in hospitalizations between the two groups for the following complications: cardiac (heart failure, edema, arrhythmias, and acute rejection) and infections. There was no significant difference in episodes of 2R and 3R rejection. <i>Conclusion</i>. Early identification and treatment of depression in OHT patients result in outcomes similar to nondepressed patients.

Ike Okwuosa

Dara Pumphrey

Jyothy Puthumana

Rachel-Maria Brown

William Cotts

Impact of Identification and Treatment of Depression in Heart Transplant Patients

<i>Introduction</i>. Among atypical antipsychotics, none has been linked to torsade de pointes. In the present study, the electrocardiographic changes induced by olanzapine have been compared with risperidone. <i>Method and Materials</i>. 268 patients were entered into an open study for random assignment to olanzapine or risperidone. ECG was taken at baseline and at the end of the treatment. The parameters that had been assessed included Q-T interval (corrected = Q-Tc) and other related parameters. Correction of the observed Q-T interval was done according to Frederica’s formula (QTcF). <i>Results</i>. While 14.86% and 25% of the cases in the olanzapine group showed prolongation and shortening of QTcF, respectively, comparable changes in the risperidone group were restricted to its prolongation (32.5%). Comparison of means between baseline QTcF of risperidone group versus its posttreatment measurement showed a significant increment <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.3616pt" id="M1" height="12.0395pt" version="1.1" viewBox="-0.0498162 -9.6779 56.1364 12.0395" width="56.1364pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-41" d="M300 -147C201 -63 143 98 143 270S200 602 300 686L282 710C136 610 70 450 70 271V270C70 89 136 -72 282 -170L300 -147Z"/></g><g transform="matrix(.0135,0,0,-0.0135,4.688,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,16.837,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,28.575,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,35.078,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,38.167,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,44.67,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.0135,0,0,-0.0135,51.173,0)"><path id="g113-42" d="M275 270C275 450 212 609 64 710L45 686C145 604 203 442 203 270S147 -63 45 -147L64 -170C213 -68 275 89 275 270Z"/></g></svg>. Also, the quantity of cases with shortening of QTcF in the olanzapine group was significantly more than its opposite <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.3616pt" id="M2" height="12.0395pt" version="1.1" viewBox="-0.0498162 -9.6779 56.1364 12.0395" width="56.1364pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-41"/></g><g transform="matrix(.0135,0,0,-0.0135,4.688,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,16.837,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,28.575,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,35.078,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,38.167,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,44.67,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.0135,0,0,-0.0135,51.173,0)"><use xlink:href="#g113-42"/></g></svg>. <i>Conclusion</i>. Comparable propensity of olanzapine and risperidone for induction of electrocardiographic changes demands adequate cautiousness by clinicians, particularly with respect to shortening of Q-T interval, which was mainly noticeable in the olanzapine group.

Saeed Shoja Shafti

Parisa Fallah Jahromi

A Comparative Study between Olanzapine and  Risperidone Regarding Drug-Induced  Electrocardiographic Changes

<i>Objective</i>. The aim of this study was to investigate the relationship between gamma-glutamyl transferase (GGT) levels, cerebrovascular risk factors, and distribution of cerebral infarct areas in patients with acute ischemic stroke (AIS). <i>Patients and Methods</i>. Sixty patients with AIS and 44 controls who had not cerebrovascular disease were included in the study. The patients were divided into four groups according to the location of the infarct area and evaluated as for GGT levels and the presence of diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL). <i>Results</i>. The frequency of DM, HT, and HL and gender distributions were similar. The mean GGT levels were significantly higher in patients with AIS and those with relatively larger areas of infarction (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.1625795pt" id="M1" height="8.9689pt" version="1.1" viewBox="0 -8.80632 46.4857 8.9689" width="46.4857pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"></path></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"></use></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"></path></g></svg>). Increased mean GGT levels were found in the subgroup with hypertension, higher LDL-cholesterol, and triglyceride levels among cases with AIS (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.1625795pt" id="M2" height="8.9689pt" version="1.1" viewBox="0 -8.80632 46.4857 8.9689" width="46.4857pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"></use></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-91"></use></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"></use></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"></use></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"></use></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><use xlink:href="#g113-54"></use></g></svg>). <i>Conclusion</i>. Higher GGT levels in AIS patients reinforce the relationship of GGT with inflammation and oxidative stress. The observation of higher GGT levels in patients with relatively larger areas of infarction is indicative of a positive correlation between increases in infarct areas and elevated GGT levels.

Nurbanu Gurbuzer

Eren Gozke

Zeliha Ayhan Basturk

Gamma-Glutamyl Transferase Levels in Patients with Acute Ischemic Stroke

<i>Introduction.</i> Psychiatric problems and stresses may deteriorate the prognosis of patients with IHD. So evaluating their frequency possibly will promote our perspective regarding their vital importance in the field of consultation-liaison psychiatry. <i>Method and Materials.</i> One hundred and one (101) patients with IHD were interviewed in CCU of a general hospital by a psychiatrist to find whether there was any relationship between cardiac events and psychiatric problems or stresses. <i>Results.</i> Cardiac events were significantly more prevalent among patients with both psychiatric problems and biological risk factors (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M1" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z"></path></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z"></path></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z"></path></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><path id="x2E" d="M113 -12q-24 0 -39.5 16t-15.5 42q0 24 16 40.5t40 16.5t40 -16.5t16 -40.5q0 -26 -16 -42t-41 -16z"></path></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z"></path></g>

		
	
</svg>). Also, the number of patients suffering from psychiatric problems was significantly more than cases without that (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M2" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x35"></use></g>

		
	
</svg>). There was a significant difference between male and female patients regarding the type of stress (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:58.712502px;" id="M3" height="11.375" version="1.1" viewBox="0 0 58.712502 11.375" width="58.712502">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z"></path></g>

		
	
</svg>). 79% of total stresses were experienced by patients who had as well psychiatric problems (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:75.025002px;" id="M4" height="11.375" version="1.1" viewBox="0 0 75.025002 11.375" width="75.025002">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,66.8,11.112)"><use xlink:href="#x31"></use></g>

		
	
</svg>). In addition, there was significantly more dysthymic disorder in the acute group of patients in comparison with major or minor depressive disorder in the chronic group (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.30096pt;width:66.875px;" id="M5" height="11.375" version="1.1" viewBox="0 0 66.875 11.375" width="66.875">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.112)"><use xlink:href="#x1D443"></use></g><g transform="matrix(.017,-0,0,-.017,15.582,11.112)"><use xlink:href="#x3C"></use></g><g transform="matrix(.017,-0,0,-.017,30.286,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,38.446,11.112)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,42.321,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,50.481,11.112)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,58.64,11.112)"><use xlink:href="#x31"></use></g>

		
	
</svg>). <i>Conclusion.</i> The high prevalence of psychiatric problems and psychosocial stresses among patients with IHD deserves sufficient attention by clinicians for detection, monitoring, and management of them.

Saeed Shoja shafti

Prevalence of Psychiatric Morbidities in Acute Coronary Heart Disease

Type 2 diabetes (T2D) is now recognized as an independent risk factor for accelerated cognitive decline and neurological conditions like Alzheimer’s disease. Less is known about the neurocognitive function of T2D patients with comorbid metabolic syndrome, despite their elevated risk for impairment. Computerized testing in 47 adults with T2D that met criteria for NCEP metabolic syndrome revealed that cognitive impairment was prevalent, including 13% in tests of memory, 50% in attention, and 35% in executive function. Partial correlations showed that longer duration of diabetes was associated with poorer performance on tests of basic attention (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:65.050003px;" id="M1" height="11.125" version="1.1" viewBox="0 0 65.050003 11.125" width="65.050003">
	
		
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</svg>), working memory (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:55.075001px;" id="M2" height="11.125" version="1.1" viewBox="0 0 55.075001 11.125" width="55.075001">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><use xlink:href="#x1D45F"></use></g><g transform="matrix(.017,-0,0,-.017,11.945,10.862)"><use xlink:href="#x3D"></use></g><g transform="matrix(.017,-0,0,-.017,26.649,10.862)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,34.808,10.862)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,38.684,10.862)"><use xlink:href="#x34"></use></g><g transform="matrix(.017,-0,0,-.017,46.843,10.862)"><use xlink:href="#x33"></use></g>

		
	
</svg>), and executive function (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:55.075001px;" id="M3" height="11.125" version="1.1" viewBox="0 0 55.075001 11.125" width="55.075001">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><use xlink:href="#x1D45F"></use></g><g transform="matrix(.017,-0,0,-.017,11.945,10.862)"><use xlink:href="#x3D"></use></g><g transform="matrix(.017,-0,0,-.017,26.649,10.862)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,34.808,10.862)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,38.684,10.862)"><use xlink:href="#x34"></use></g><g transform="matrix(.017,-0,0,-.017,46.843,10.862)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z"></path></g>

		
	
</svg>). Strong associations between very low density lipoprotein and poor cognitive function also emerged, including tests of set shifting (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:55.075001px;" id="M4" height="11.125" version="1.1" viewBox="0 0 55.075001 11.125" width="55.075001">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><use xlink:href="#x1D45F"></use></g><g transform="matrix(.017,-0,0,-.017,11.945,10.862)"><use xlink:href="#x3D"></use></g><g transform="matrix(.017,-0,0,-.017,26.649,10.862)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,34.808,10.862)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,38.684,10.862)"><use xlink:href="#x34"></use></g><g transform="matrix(.017,-0,0,-.017,46.843,10.862)"><path id="x37" d="M447 623l8 -12l-283 -613l-74 -10l-7 11q174 283 297 551h-216q-48 0 -62.5 -12t-33.5 -63h-29q10 60 18 148h382z"></path></g>

		
	
</svg>) and cognitive inhibition (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.17555pt;width:65.050003px;" id="M5" height="11.125" version="1.1" viewBox="0 0 65.050003 11.125" width="65.050003">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><use xlink:href="#x1D45F"></use></g><g transform="matrix(.017,-0,0,-.017,11.945,10.862)"><use xlink:href="#x3D"></use></g><g transform="matrix(.017,-0,0,-.017,26.649,10.862)"><use xlink:href="#x2212"></use></g><g transform="matrix(.017,-0,0,-.017,36.627,10.862)"><use xlink:href="#x30"></use></g><g transform="matrix(.017,-0,0,-.017,44.786,10.862)"><use xlink:href="#x2E"></use></g><g transform="matrix(.017,-0,0,-.017,48.662,10.862)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z"></path></g><g transform="matrix(.017,-0,0,-.017,56.821,10.862)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z"></path></g>

		
	
</svg>). Findings suggest that patients with T2D that meet criteria for metabolic syndrome are at high risk for cognitive impairment. Prospective studies should look to replicate these findings and examine the possible neuroprotective effects of lipid-lowering medication in this population.

Divya Yogi-Morren

Rachel Galioto

Sarah Elizabeth Strandjord

L. Kennedy

Pooja Manroa

John P. Kirwan

Sangeeta Kashyap

John Gunstad

Duration of Type 2 Diabetes and Very Low Density Lipoprotein Levels Are Associated with Cognitive Dysfunction in Metabolic Syndrome

A narrative review of the major evidence concerning the relationship between emotional regulation and depression was conducted. The literature demonstrates a mediating role of emotional regulation in the development of depression and physical illness. Literature suggests in fact that the employment of adaptive emotional regulation strategies (e.g., reappraisal) causes a reduction of stress-elicited emotions leading to physical disorders. Conversely, dysfunctional emotional regulation strategies and, in particular, rumination and emotion suppression appear to be influential in the pathogenesis of depression and physiological disease. More specifically, the evidence suggests that depression and rumination affect both cognitive (e.g., impaired ability to process negative information) and neurobiological mechanisms (e.g., hypothalamic pituitary adrenal axis overactivation and higher rates of cortisol production). Understanding the factors that govern the variety of health outcomes that different people experience following exposure to stress has important implications for the development of effective emotion-regulation interventional approaches (e.g., mindfulness-based therapy, emotion-focused therapy, and emotion regulation therapy).

Angelo Compare

Cristina Zarbo

Edo Shonin

William Van Gordon

Chiara Marconi

Emotional Regulation and Depression: A Potential Mediator between Heart and Mind

<i>Background</i>. Obstructive sleep apnea (OSA) syndrome is one of the most common respiratory disorders in humans. 
                  There is emerging evidence linking OSA to vascular disease, particularly hypertension. The underlying pathophysiological mechanisms that link OSA 
                  to cardiovascular diseases such as hypertension, congestive heart failure, and atrial fibrillation are not entirely understood. 
                  The aim of this study was to investigate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) with coronary atherosclerotic disease (CAD). 
                  <i>Methods</i>. A questionnaire survey based on Berlin questionnaire and Epworth Sleepiness Scale (ESS) was conducted among 
                  406 patients to assess demographic data and the symptoms, such as excessive daytime sleepiness and snoring. 
                  Epworth Sleepiness Scale and Berlin questionnaire were completed by all of the patients. Venous blood samples were 
                  obtained for biochemical tests. Characteristics of coronary arteries were collected from angiographies&#x2019; reports. 
                  All patients were divided into two groups based on results from Berlin questionnaire: low risk patients for OSA and high risk patients for OSA. 
                  Data were analyzed by SPSS software version 13. <i>Results</i>. Mean age of patients was 
                  <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.3629799pt" id="M1" height="8.69876pt" version="1.1" viewBox="-0.0498162 -8.33578 58.2666 8.69876" width="58.2666pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-55" d="M141 347C171 480 264 541 327 570C364 587 403 599 436 605L429 641C389 634 339 622 300 609C191 570 37 458 37 239C37 86 126 -12 245 -12C367 -12 454 89 454 210C454 314 380 397 272 397C252 397 230 390 208 380L141 347ZM231 338C323 338 366 257 366 174C366 108 340 27 263 27C180 27 129 123 129 244C129 268 130 292 135 310C158 323 193 338 231 338Z"/></g><g transform="matrix(.013,0,0,-0.013,6.331,0)"><path id="g50-50" d="M389 0V32C297 38 291 46 291 118V635C234 613 175 595 109 583V556L161 554C203 552 207 547 207 497V118C207 46 201 38 110 32V0H389Z"/></g><g transform="matrix(.013,0,0,-0.013,12.662,0)"><path id="g50-47" d="M117 -12C153 -12 178 12 178 50C178 84 153 110 118 110C84 110 59 84 59 50C59 12 84 -12 117 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,15.743,0)"><path id="g50-57" d="M253 635C142 635 71 555 71 471C71 401 113 353 178 316C144 294 106 267 91 252C70 231 46 202 46 157C46 51 132 -12 241 -12C328 -12 442 52 442 168C442 257 379 305 311 343C354 373 380 398 388 407C406 428 417 458 417 487C417 568 348 635 253 635ZM240 600C288 600 340 563 340 481C340 423 313 387 279 360C207 394 148 427 148 499C148 549 182 600 240 600ZM252 23C188 23 129 73 129 163C129 217 162 266 211 298C289 260 360 217 360 144C360 69 312 23 252 23Z"/></g><g transform="matrix(.013,0,0,-0.013,25.015,0)"><path id="g54-37" d="M556 297V350H337V548H275V350H56V297H275V85H337V297H556ZM556 -23V30H56V-23H556Z"/></g><g transform="matrix(.013,0,0,-0.013,35.898,0)"><use xlink:href="#g50-50"/></g><g transform="matrix(.013,0,0,-0.013,42.229,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z"/></g><g transform="matrix(.013,0,0,-0.013,48.56,0)"><use xlink:href="#g50-47"/></g><g transform="matrix(.013,0,0,-0.013,51.641,0)"><path id="g50-54" d="M158 548H390L417 615L410 623H122L83 318C105 326 143 337 185 337C296 337 350 275 350 188C350 116 308 42 225 42C164 42 122 74 100 93C90 101 82 99 72 92C60 82 51 68 50 59C48 46 52 38 66 24C82 9 125 -12 172 -12C225 -11 292 15 346 59C408 108 437 166 437 226C437 309 371 397 242 397C214 397 170 382 133 369L158 548Z"/></g></svg>.  
212 (52.2&#x25;) patients were categorized as high risk group for apnea. Also, excessive daytime sleepiness was reported in 186 patients (45.8&#x25;). The severity of coronary artery involvement, daytime sleepiness, and electrocardiogram abnormalities was significantly higher in high risk patients for OSA compared with low risk patients. High risk patients had higher level of FBS and LDL and lower level of HDL cholesterol <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-2.18977pt" id="M2" height="11.4781pt" version="1.1" viewBox="-0.0498162 -9.28833 55.0391 11.4781" width="55.0391pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-41" d="M309 -142C211 -61 151 99 151 271S210 601 309 683L288 710C141 611 75 451 75 272V271C75 90 141 -72 288 -169L309 -142Z"/></g><g transform="matrix(.013,0,0,-0.013,4.654,0)"><path id="g50-81" d="M622 479C622 589 545 650 400 650H146L140 618C229 609 230 602 215 527L135 132C117 43 112 41 27 32L18 0H305L313 32C213 40 205 44 222 132L251 284L324 262H365C484 269 622 333 622 479ZM528 477C528 356 420 305 344 305C300 305 276 314 259 321L303 554C311 597 313 600 331 606C345 611 361 614 379 614C463 614 528 580 528 477Z"/></g><g transform="matrix(.013,0,0,-0.013,16.42,0)"><path id="g54-91" d="M530 -6V57L144 261V263L530 468V530L81 290V234L530 -6Z"/></g><g transform="matrix(.013,0,0,-0.013,28.039,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,34.37,0)"><use xlink:href="#g50-47"/></g><g transform="matrix(.013,0,0,-0.013,37.451,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,43.782,0)"><use xlink:href="#g50-54"/></g><g transform="matrix(.013,0,0,-0.013,50.113,0)"><path id="g50-42" d="M283 271C283 451 220 610 70 710L48 683C146 603 207 443 207 271S149 -59 48 -142L70 -169C220 -67 283 90 283 271Z"/></g></svg>. <i>Conclusion</i>. Our study found a strong correlation between the number of stenotic vessels and OSA. Based on our findings, OSA can be a predisposing factor for cardiac diseases.

Hamid Reza Javadi

Shabnam Jalilolghadr

Zohreh Yazdi

Zeinab Rezaie Majd

Correlation between Obstructive Sleep Apnea Syndrome and Cardiac Disease Severity

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Cardiovascular Psychiatry and Neurology