Gender differences in quality of life are minimal in patients with heart failure

BACKGROUND: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction. METHODS: Data from a sample of 640 men and women (50% each) matched on New York Heart Association functional classification and age were used for this secondary analysis. Scores on the Minnesota Living with Heart Failure Questionnaire were compared at baseline and 3 months after enrollment using multivariate techniques with ejection fraction controlled. Treatment group (intervention versus control) was controlled statistically at 3 months because the original data were drawn from experimental and quasi-experimental studies in which an improvement in quality of life had been a goal of the intervention. The sexes differed on marital status, so this variable was controlled in analyses as well. RESULTS: In all analyses, quality of life was minimally worse in women compared with men (1-3 points at most). None of the differences reached statistical significance except for emotional quality of life at baseline (P =.03). By 3 months, both men and women reported significantly improved and comparable quality of life and there were no significant differences between them. CONCLUSION: Quality of life is similar in men and women with heart failure when functional status, age, ejection fraction, and marital status differences are controlled.     

Antiretroviral protease inhibitors prevent l6 muscle cell fusion by reducing calpain activity

The antiretroviral protease inhibitors indinavir (IDV) and ritonavir (RTV) are used in highly active antiretroviral therapies (HAART). Side effects from long-term HAART therapy include loss of muscle mass. Myoblasts when cultured in media low in growth factors withdraw from the cell cycle, express muscle-specific differentiation inducers and proteins, and fuse to form myotubes. The neutral protease, calpain, is required for myotube formation and RTV decreased calpain activity in vitro. We found lower calpain activity, but not protein, in homogenates of RTV-treated L6 cells than in control cultures. Importantly, L6 and C2C12 myoblasts did not form myotubes when cultured with 10 or 20 microM IDV or RTV. Control and drug-related L6 myoblasts showed identical decreases in proliferating cell nuclear antigens expression indicating proliferation arrest. Similarly, muscle differentiation inducers MyoD and myogenin and their downstream target, myosin heavy chain, were expressed at similar levels in control and drug-treated cells. Thus, whereas muscle differentiation was unaffected by protease inhibitors, calpain activity was reduced and myotube formation prevented. We conclude that RTV and IDV reduced myotube formation by reducing calpain activity. Our data suggest that protease inhibitors included in HAART might be directly involved in muscle wasting by reducing muscle remodeling.     

Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability

Purpose

Neurologic and endothelial injury biomarkers are associated with prolonged delirium during critical illness and may reflect injury pathways that lead to poor long-term outcomes. We hypothesized that blood–brain barrier (BBB), neuronal, and endothelial injury biomarkers measured during critical illness are associated with cognitive impairment and disability after discharge.

Methods

We enrolled adults with respiratory failure and/or shock and measured plasma concentrations of BBB (S100B), neuronal (UCHL1, BDNF), and endothelial (E-selectin, PAI-1) injury markers within 72 h of ICU admission. At 3 and 12 months post-discharge, we assessed participants’ global cognition, executive function, and activities of daily living (ADL). We used multivariable regression to determine whether biomarkers were associated with outcomes after adjusting for relevant demographic and acute illness covariates.

Results

Our study included 419 survivors of critical illness with median age 59 years and APACHE II score 25. Higher S100B was associated with worse global cognition at 3 and 12 months (P?=?0.008; P?=?0.01). UCHL1 was nonlinearly associated with global cognition at 3 months (P?=?0.02). Higher E-selectin was associated with worse global cognition (P?=?0.006 at 3 months; P?=?0.06 at 12 months). BDNF and PAI-1 were not associated with global cognition. No biomarkers were associated with executive function. Higher S100B (P?=?0.05) and E-selectin (P?=?0.02) were associated with increased disability in ADLs at 3 months.

Conclusions

S100B, a marker of BBB and/or astrocyte injury, and E-selectin, an adhesion molecule and marker of endothelial injury, are associated with long-term cognitive impairment after critical illness, findings that may reflect mechanisms of critical illness brain injury.

     

Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMADs) are a public health issue that has a profound negative effect on women, families, and communities. It is estimated that 15% to 21% of pregnant and postpartum women experience PMAD, which includes depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and postpartum psychosis. The purpose of this article is to provide an overview of perinatal mood and anxiety disorders in an effort to improve recognition, screening, diagnosis, treatment, and referral by nurse practitioners and midwives.     

Paravalvular regurgitation one year after transcatheter aortic valve implantation

Objectives : The aim of this study was to assess the natural history of paravalvular regurgitation at 1 year in patients undergoing TAVI. Background : The immediate incidence of paravalvular regurgitation is estimated to be between 65 and 85% following transcatheter aortic valve implantation (TAVI). There is limited data as to whether this deteriorates during follow‐up. Methods : Forty‐six patients were recruited from a TAVI programme at our institute. All patients underwent an assessment of prosthetic valve function periprocedurally with aortography and immediately postprocedurally with transthoracic echocardiography. Twenty‐one patients with a median age was 83 (66–91) years of whom 14 were male reached 1 year follow‐up, 13 of whom were available for repeat transthoracic echocardiography. Results : The incidence of paravalvular regurgitation immediately following TAVI was 86%. Of them 57% had ≤ mild regurgitation and 29% had > mild regurgitation. At 1 year the incidence of paravalvular regurgitation was 77%. 54% had ≤ mild regurgitation and 34% > mild regurgitation. No patient had severe regurgitation. The degree of regurgitation reduced in 6 (46%), stayed the same in 3 (23%), and increased in 4 (31%) of patients. Conclusions : Patients undergoing TAVI have an immediate postprocedural risk of regurgitation of 86%. In the majority of cases the degree of paravalvular CoreValve® regurgitation is mild, and remains stable in 70% of patients during medium term follow‐up. © 2009 Wiley‐Liss, Inc.