Julia L Newton

..Here we present the first study examining a potential genetic abnormality in VVS...

..Clinical findings included an absence of any discernible cardiac or autonomic abnormalities and reproducible hypotension on tilt table testing in affected family members...

..This would allow greater numbers of older subjects to gain the benefits associated with aspirin use...

..This predicts overall fracture risk as effectively as dual X-ray at the spine and hip, although site specific measurements provide the best estimate of fracture risk at a particular location...

..All subjects post-intervention were able to return to work or schooling. CBT is an effective treatment in those with difficult to manage VVS. Randomized controlled trials are needed...

..001). There is significant pepsin activity in the stomach throughout the 24-hr period, with a trend for the highest activity through the night. Subjects with H. pylori infection have lower luminal pepsin activity...

..We have assessed heart rate variability (HRV) and baroreflex sensitivity (BRS) risk factors associated with cardiovascular mortality, in 57 PBC patients and age- and sex-matched normal controls...

..Here, we investigate the prevalence of autonomic dysfunction using highly sensitive detection modalities and its relationship with fatigue in both noncirrhotic and cirrhotic primary biliary cirrhosis patients...

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..Cognitive impairment is recognised in the early stages of primary biliary cirrhosis (PBC)...

..To increase exercise in NAFLD it is important to understand the barriers to performing it...

..Cognitive impairment is, in turn, associated with structural brain lesions and autonomic dysfunction, which may predict risk of cognitive decline...

..To detect possible autonomic changes due to home orthostatic training (HOT) and to assess the feasibility of a larger, placebo-controlled study of HOT in vasovagal syncope (VVS)...

..With risk factors such as autonomic dysfunction, cognitive impairment, and muscle abnormalities in CLD it is expected that falls and injury will be common...

..Further study is warranted to address the mechanisms responsible for post-transplant functional impairment and to develop effective rehabilitation regimes to maximize function following liver transplantation...

..We conducted a case-control study evaluating this relationship in a large patient cohort...

..Autonomic dysfunction is independently associated with both fatigue and, importantly, symptoms of cognitive dysfunction, suggesting the potential for significant organic sequelae...

..Alternative methods of diagnosing vasovagal syncope would thus be useful...

..We examined the relationship between parameters of blood pressure regulation with perception of fatigue in NAFLD...

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..These results identify potential therapies for treatment of gastric mucosal morbidity and age-associated loss of appetite...

..This is analogous to the changes found in healthy aging for subjects ∼16 yr older than the fatigued PBC patients. Hence the hearts of fatigued PBC patients may be subject to processes of accelerated aging...

..We believe that such a systematic approach, when applied to research as well as to clinical management, will allow us to reduce the overall burden of chronic liver disease, improve quality of life and enhance functional ability...

..To investigate whether levels of psychosocial impairment and psychological distress at diagnosis in those with vasovagal syncope (VVS) predict subsequent response to conventional treatment...

..This study examined the relationship between skeletal and cardiac muscle function and symptoms on standing in CFS using magnetic resonance spectroscopy (MRS) and impedance cardiography...

..The cause of CFS remains unknown and there are no effective treatments...

..To quantify the prevalence of fatigue and its severity in vasovagal syncope (VVS) and to examine whether fatigue severity associates with symptoms of autonomic dysfunction...

..To assess patient-reported functional ability and its relationship with symptoms in primary biliary cirrhosis (PBC)...

..Consideration of these symptoms affecting patients with NAFLD and, where possible, effective treatment will lead to improvements in quality of life and enhance the ability of those with NAFLD to function in their daily lives...

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..carotid sinus hypersensitivity (CSH) is associated with syncope, drop attacks and unexplained falls in older people. However, a recent study has also reported a prevalence of 35% in asymptomatic community-dwelling older people...

..06, 27.4). The front-loaded GTN protocol provided a higher diagnostic rate than passive tilt testing, and provides a rapid alternative to conventional methods, though false positivity rates are higher...

..Although anti-PDC inhibits PDC function in vitro, mitochondrial function in vivo in PBC has not been examined...

..To address this issue, we investigated the age distribution and differences in clinical characteristics associated with age in patients diagnosed with VVS by HUTT at our tertiary referral centre...

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..Non-alcoholic fatty liver disease (NAFLD) is principally a disease of middle and old age. Previous studies reported it to be benign in old age, however more recent studies suggest an increased mortality in the >60-year-olds...

..To determine the prevalence of autonomic dysfunction (dysautonomia) among patients with primary Sjögren's syndrome (PSS) and the relationships between dysautonomia and other clinical features of PSS...

..We investigated the prevalence and impact of falls, and the overlap between falls, dizziness and blackouts, in a population-based sample of 85 year olds...

..Chronic fatigue syndrome (CFS) patients frequently describe difficulties with repeat exercise. Here, we explore muscle bioenergetic function in response to three bouts of exercise...

..27 vs 0.156; P = 0.009; OR = 2.01). Our results suggest that the relationship among IL-1 gene polymorphism, H. pylori, and disease is more complex than initially proposed. More detailed studies of the IL-1 gene cluster are needed...

..Management strategies are similar irrespective of age or gender, but evidence is lacking specific to older populations...

..Existing agents effective at reducing daytime somnolence (such as modafinil) hold potential for the treatment of fatigue in PBC...

..Conventional therapy is effective in less than 60%. Case reports suggest ivabradine (a selective sinus node blocker, with no effect on blood pressure) may alleviate POTS-related symptoms. This is a retrospective case-series...

..Cognitive impairment commonly associates with autonomic dysfunction. Here, we quantified cognitive symptoms in a large cohort of patients with ITP compared with controls and explored the relationship with autonomic symptoms...

..CONCLUSIONS: Symptoms of syncope on defaecation are associated with autonomic failure. With appropriate therapeutic intervention our subjects all improved...

..TFF2 is considered the major cytoprotective gastric trefoil protein. There is a marked circadian variation in gastric luminal TFF2 in young healthy volunteers with peak levels present during the night...

..Comprehensive studies investigating the pathogenesis of fatigue in PBC are urgently needed as are large-scale prospective outcome studies...

..The aim of this study was to explore the inter-relationship between UDCA use, response, and fatigue in determining outcome over 9 years in a unique, comprehensive patient cohort...

..Easy-to-use algorithms can help reduce the number of patients admitted to acute medical services with falls and syncope while optimising the care of those managed as inpatients. The algorithms are provided for use by interested parties...

..Vasovagal syncope is an exaggerated form of the common faint affecting all age groups. Aetiology is unknown but the tendency for the disease to run in families has previously been noted...

..Further, this distress may actually influence the natural history of what is a chronic relapsing condition and may in fact be more relevant to the patient than the number of syncopal episodes that they are experiencing...

..The cause remains unclear and treatment is challenging. Restless leg syndrome (RLS) is a common sleep disorder. In this study, we systematically screened PBC patients for the presence of RLS...

..As morbidity and mortality is increased in CLD patients with AD its recognition, investigation and management is important to all who encounter such patients...

..Patients with primary immune thrombocytopenia (ITP) commonly describe symptoms of fatigue. However, hematologists rarely consider fatigue a manifestation of ITP...

..Further studies of the effect of gastroscopy upon blood pressure are required, particularly in older patients, the group regarded as at increased risk from complications...

..This review emphasises how the stomach changes with age, and how understanding this will aid clinicians when prescribing medications with potential gastrointestinal adverse effects to older people...

..The role of family practitioners in the on-going maintenance of gastrointestinal diseases and in the management of Helicobacter pylori in community dwelling older people is also considered...

..TFF2 secretion increases during inactivity and sleep. These results suggest that secretion of TFF2 in the stomach is highest during the night and that the cytoprotective effects of TFF2 on the gastric mucosa occur mainly during sleep...

..Peptic ulceration and Helicobacter pylori infection increase with advancing age. In the upper gastro-intestinal tract the first line of mucosal defence is the adherent mucus gel layer...

..Therefore, we performed a clinical cohort study to examine and differentiate the clinical and autonomic features in CFS patients aged over 50...

..We believe that introducing such a DVD into clinical practice, following diagnosis, will make a real difference to the quality of life of newly-diagnosed PBC patients...

..TFF2 is also detected at high concentrations around sites of ulceration. It is protective against mucosal damaging agents and stimulates cell motility...

..Natural history of Vasovagal syndrome (Neurocardiogenic; NCS) is unclear...

..Here we explore how these biological associates inter-relate, and their cumulative impact upon typical clinical cohorts...

..To refine this association, we performed a case-control association study using both SNPs and microsatellite markers in haplotypes matched either for HLA-DRB1*0404 or for HLA-DRB1*0401...

..01). There was one cardiovascular and no neurological complications. CONCLUSION: This study included 10 times as many people as previous studies and demonstrates the safety of HUT in older people...

..We have formally explored how these two perspectives of chronic disease management can be combined into a clinic consultation and impact upon quality of life (QOL) in PBC...

..However, preliminary experience suggests that unravelling the genetic component of common inflammatory disorders, such as rheumatoid arthritis, multiple sclerosis and systemic lupus erythematosus, might be a harder nut to crack...

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