Generic and disease-specific health-related quality of life in patients with chronic systolic heart failure: impact of depression

Aims

Heart failure is known to profoundly affect health-related quality of life (HRQoL). We aimed to describe both generic and disease-specific HRQoL in a large community-based sample of patients with systolic heart failure (SHF) and to identify important somatic and psychosocial correlates.

Methods and results

Seven hundred and two patients, 67 ± 12 years old, 71 % men, with distributions of New York Heart Association (NYHA) functional classes I/II/III/IV of 2/55/39/4 % were included in this cross-sectional analysis. Generic HRQoL was measured with the SF-36 health survey, disease-specific HRQoL with the Kansas City Cardiomyopathy Questionnaire, and depression with the self-reported Patient Health Questionnaire (PHQ-9). Both generic- and disease-specific HRQoL measurements indicated moderate to poor HRQoL. The KCCQ scores demonstrated higher sensitivity to the varying levels of heart failure severity as compared to the SF-36 scores. Patients with either a minor (15 %) or a major depression (24 %) reported significantly and substantially lower HRQoL (p < .001) than patients without depression did. In multivariable regression analyses, depression accounted for the largest part of the variance of both generic and specific HRQoL (12 and 36 %, respectively), whereas most biomedical variables had no or only a marginal influence.

Conclusion

Patients with SHF suffer from severe limitations of HRQoL. Depression was the most important correlate of both generic and disease-specific HRQoL.     

Aqueous extracts and polysaccharides from Liquorice roots (Glycyrrhiza glabra L.) inhibit adhesion of Helicobacter pylori to human gastric mucosa

Aims

Aqueous extracts from the roots of Glycyrrhiza glabra L. (Fabaceae) are widely used for treatment of stomach ulcer. The clinical proven effects are related to the presence of anti-inflammatory 12-keto-triterpensaponins in the extracts. Apart from that the influence of Glycyrrhiza glabra extract on the bacterial adhesion of Helicobacter pylori to stomach tissue was to be investigated. Additionally the influence of Glycyrrhiza glabra secondary compounds on the bacterial adhesion of Porphyromonas gingivalis, a major pathogen for induction of periodontal inflammations was to be investigated.

Methodology

In vitro cytotoxicity against Helicobacter pylori was investigated by agar diffusion assay; antiadhesive properties of aqueous extract, raw polysaccharides and purified polysaccharide fractions was investigated by means of an in situ adhesion assay with FITC-labelled bacteria on tissue slides of human stomach resectates.

Results

Aqueous extract (1 mg/mL) of Glycyrrhiza glabra significantly inhibited the adhesion of Helicobacter pylori to human stomach tissue. This effect was related to the polysaccharides isolated from the extract, with one purified acidic fraction (0.25 SPB) as main active polymer. Purified polysaccharides did not exhibit direct cytotoxic effects against Helicobacter pylori and did not influence hemagglutination. Additionally raw polysaccharides from Glycyrrhiza glabra were shown to have strong antiadhesive effects against Porphyromonas gingivalis.

Conclusion

Aqueous extracts and polysaccharides from the roots of Glycyrrhiza glabra are strong antiadhesive systems, which may be used as potent tools for a further development of cytoprotective preparations with anti-infectious potential.     

The German Short Musculoskeletal Function Assessment questionnaire: reliability, validity, responsiveness, and comparison with the Short Form 36 and Constant score—a prospective evaluation of patients undergoing repair for rotator cuff tear

In a prospective clinical trial, first the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D) was tested for reliability, validity, and responsiveness in 23 patients with rotator cuff tears, and secondly the Short Form (SF)-36, and the Constant score were evaluated comparatively in 45 patients with rotator cuff tear undergoing open repair. Retest reliability was excellent for the functional index of the SMFA-D and satisfactory for the bother index. The SMFA-D showed good validity and responsiveness. All three instruments demonstrated significantly the positive effect of rotator cuff repair at 12-month follow-up. Using comparable scales, effect sizes were bigger with the SMFA-D than with the SF-36 and as big as the Constant score. Significant correlations of the SMFA-D indices with the SF-36 scales and the Constant score could be shown preoperatively. At 12-month follow-up, all correlations between SMFA-D indices, SF-36 scales, and Constant score function scales were still significant. We recommend use of the SMFA-D to assess changes in functional status concerning patients with rotator cuff tear undergoing open repair.This study is a project of the Rehabilitation Research Network of Bavaria funded by the German Ministry of Education and Research and the German Statutory Pension Insurance ().     

1H-MR spectroscopy for analysis of cardiac lipid and creatine metabolism

Magnetic resonance spectroscopy (MRS) is the only non-invasive, non-radiation-based technique for investigating the metabolism of living tissue. MRS of protons (¹H-MRS), which provides the highest sensitivity of all MR-visible nuclei, is a method capable of detecting and quantifying specific cardiac biomolecules, such as lipids and creatine in normal and diseased hearts in both animal models and humans. This can be used to study mechanisms of heart failure development in a longitudinal manner, for example, the potential contribution of myocardial lipid accumulation in the context of ageing and obesity. Similarly, quantifying creatine levels provides insight into the energy storage and buffering capacity in the heart. Creatine depletion is consistently observed in heart failure independent of aetiology, but its contribution to pathophysiology remains a matter of debate. These and other questions can in theory be answered with cardiac MRS, but fundamental technical challenges have limited its use. The metabolites studied with MRS are much lower concentration than water protons, requiring methods to suppress the dominant water signal and resulting in larger voxel sizes and longer scan times compared to MRI. However, recent technical advances in MR hardware and software have facilitated the application of ¹H-MRS in humans and animal models of heart disease as detailed in this review.     

Massive gastrointestinal bleeding in Henoch-Schoenlein purpura in an adult

Henoch-Schoenlein syndrome in an adult patient, localised only to the gastrointestinal system is very rare. A 50 year old male was treated in our Intensive Department because of acute respiratory distress syndrome (ARDS) and renal failure. After temporary improvement massive gastrointestinal bleeding developed with shock. Blood was found in the descending duodenum without evident pathology at endoscopy. Angiogram showed bleeding at the hepatic flexure of the colon, which was successfully treated by a coil and bleeding was also present in the terminal part of the small intestine. The catheter was left in situ and the bleeding part of the bowel was painted intraoperatively, so we could resect the stained part of the intestine. Because of rebleeding, bowel resection was performed an other two occasions in the same way. The histology of the bowel showed Henoch-Schoenlein syndrome in each specimen. Our patient was totally non-responsive to treatment, which is usually successful in this disease. After the resections the bleeding stopped temporarily, but as the underlying disease was unmanageable the patient died but we have not found any surgical complication at autopsy. We think that this method in the surgical treatment of massive intestinal bleeding is very useful and effective.     

Styrene-7,8-oxide burden in ventilated, perfused lungs of mice and rats exposed to vaporous styrene.

Styrene (ST) is an important industrial chemical. In long-term inhalation studies, ST-induced lung tumors in mice but not in rats. To test the hypothesis that the lung burden by the reactive metabolite styrene-7,8-oxide (SO) would be most relevant for the species-specific tumorigenicity, we investigated the SO burden in isolated lungs of male Sprague-Dawley rats and in-situ prepared lungs of male B6C3F1 mice ventilated with air containing vaporous ST and perfused with a modified Krebs-Henseleit buffer (37 degrees C). Styrene vapor concentrations were determined in air samples collected in the immediate vicinity of the trachea. They were almost constant during each experiment. Styrene exposures ranged from 50 to 980 ppm (rats) and from 40 to 410 ppm (mice). SO was quantified from the effluent perfusate. Lungs of both species metabolized ST to SO. After a mathematical translation of the ex-vivo data to ventilation and perfusion conditions as they are occurring in vivo, a species comparison was carried out. At ST concentrations of up to 410 ppm, mean SO levels in mouse lungs ranged up to 0.45 nmol/g lung, about 2 times higher than in rat lungs at equal conditions of ST exposure. We conclude that the species difference in the SO lung burden is too small to consider the genotoxicity of SO as sufficient for explaining the fact that only mice developed lung tumors when exposed to ST. Another cause is considered as driving force for lung tumor development in the mouse.     

Isolated massive pleural effusion caused by pancreatico-pleural fistula

BACKGROUND: Massive pleural effusions are uncommon but well-documented complications of chronic pancreatitis, usually caused by the development of a pancreaticopleural fistula. The mechanism of the fistula formation is thought to be rupture of the pancreatic duct or pseudocyst. MATERIAL AND METHODS: In the past 7 years we have treated 5 patients with massive pleural effusion of pancreatic origin in the Surgical Department of Semmelweis University Medical School. 4 patients were males; the average age was 52 years (range: 46-59 years). RESULTS: All 5 patients had a history of alcohol abuse and were admitted to the pulmonary department because of respiratory distress. Other symptoms such as abdominal pain, chest pain, or weight loss were not always present. The diagnosis was confirmed by a markedly elevated amylase level in the aspirated pleural fluid. Abdominal ultrasound, CT scan, and ERCP examinations were carried out in order to determine the cause of the pancreaticopleural fistula. Conservative (nonsurgical) treatment was effective within 3 weeks in only one case. The other 4 patients required surgical management. In 3 cases distal pancreatic resection with splenectomy and cholecystectomy was done. In one case cystojejunostomy was performed. All 5 patients have been cured with complete resolution of their pleural effusions. CONCLUSIONS: Patients with large pleural effusions may have underlying pancreatitis with a pancreaticopleural fistula. It is important to establish this diagnosis because treatment may require operative interventions.