Clinical characteristics of patients with increased urinary excretion of adrenaline in mild to moderate heart failure

BACKGROUND: We have previously demonstrated that adrenaline (AD) is released into the circulation during acute myocardial infarction and is associated with a more severe clinical course. The role of elevated AD levels in congestive heart failure is not known. HYPOTHESIS: The study aimed to determine whether increased daily AD excretion is associated with more severe clinical symptoms and a more complicated clinical course in patients with exacerbation of congestive heart failure (CHF). METHODS: Urinary excretion of AD, noradrenaline, magnesium (Mg), and potassium (K), serum levels of aldosterone, K, and Mg, as well as the incidence of arrhythmias (24-h Holter) were assessed in 49 patients with CHF New York Heart Association (NYHA) class II-III. The patients were allocated to two groups, with normal (Group 1) and increased (Group 2) excretion of AD. RESULTS: Groups 1 and 2 did not differ in respect of age, etiology of CHF, or the medication used. Also, left ventricular ejection fraction was similar in the two groups. However, left ventricular end-diastolic dimension was greater in Group 2 (61+/-9 vs. 55+/-11 mm, p<0.05), as was the proportion of patients in NYHA class III (74 vs. 40%). Group 2 was also characterized by increased urinary excretion of Mg (60+/-24 vs. 43+/-16 mg/24 h, p < 0.007) and the presence of more complex and numerous ventricular arrhythmias (74 vs. 37% and 68 vs. 33% of patients, respectively). CONCLUSIONS: Urinary excretion of AD is increased only in a subgroup of patients with CHF. These patients are characterized by a more advanced NYHA class, increased end-diastolic left ventricular diameter, and increased urinary excretion of magnesium. It is likely that all these factors contribute to the presence of more complex and numerous ventricular arrhythmias in this subgroup of patients.     

Postpartum Streptococcus pyogenes Outbreak in the Labor and Delivery Unit of a Quaternary Referral Center: a Case Series and Review of the Literature

Historically, childbirth was associated with morbidity and mortality, often due to endometritis or puerperal fever. Streptococcus pyogenes was first identified as the cause of puerperal fever by Louis Pasteur, and it remains a virulent and lethal pathogen with a case fatality rate of 15 to 20% [1]. The pathogenesis of postpartum endometritis is believed to be associated with disruption of the woman's mucosal barriers from childbirth and invasion of bacteria either from vaginal flora or from a health care worker's hands [2]. Despite the implementation of hand sanitizing and barrier precautions (gloves), outbreaks of S. pyogenes still occur today [1]. This article provides an overview of the role of S. pyogenes in postpartum infections and describes an outbreak of postpartum endometritis due to S. pyogenes. The case report involved three patients who were admitted to a quaternary care medical center on the same day and, following discharge, were all readmitted with sepsis and endometritis. The bacteria were isolated, and pulsed-field gel electrophoresis revealed that the three S. pyogenes strains were genetically identical.     

Ageing with elegans: a research proposal to map healthspan pathways

Human longevity continues to increase world-wide, often accompanied by decreasing birth rates. As a larger fraction of the population thus gets older, the number of people suffering from disease or disability increases dramatically, presenting a major societal challenge. Healthy ageing has therefore been selected by EU policy makers as an important priority (http://www.healthyageing.eu/european-policies-and-initiatives); it benefits not only the elderly but also their direct environment and broader society, as well as the economy. The theme of healthy ageing figures prominently in the Horizon 2020 programme (https://ec.europa.eu/programmes/horizon2020/en/h2020-section/health-demographic-change-and-wellbeing), which has launched several research and innovation actions (RIA), like “Understanding health, ageing and disease: determinants, risk factors and pathways” in the work programme on “Personalising healthcare” (https://ec.europa.eu/research/participants/portal/desktop/en/opportunities/h2020/topics/693-phc-01-2014.html). Here we present our research proposal entitled “ageing with elegans” (AwE) (http://www.h2020awe.eu/), funded by this RIA, which aims for better understanding of the factors causing health and disease in ageing, and to develop evidence-based prevention, diagnostic, therapeutic and other strategies. The aim of this article, authored by the principal investigators of the 17 collaborating teams, is to describe briefly the rationale, aims, strategies and work packages of AwE for the purposes of sharing our ideas and plans with the biogerontological community in order to invite scientific feedback, suggestions, and criticism.     

α-Linolenic acid, linoleic acid and heart failure in women

α-Linolenic acid (18?:?3n-3) intake and linoleic acid (18?:?2n-6) intake have been associated with lower rates of CHD, though results have not been consistent. The relationship of these fatty acids with incident heart failure (HF) is not well established. We examined the hypothesis that women with higher intakes of 18?:?3n-3 and 18?:?2n-6 would have lower rates of HF hospitalisation and mortality. We measured 18?:?3n-3 and 18?:?2n-6 intake in 36?234 Swedish Mammography Cohort participants aged 48-83 years using FFQ and followed participants through Swedish inpatient and cause-of-death registers from 1 January 1998 until 31 December 2006. Cox models were used to calculate incidence rate ratios (RR) and 95?% CI. Because of multicollinearity, 18?:?3n-3 and 18?:?2n-6 were examined separately. Over 9 years, 596 women were hospitalised and fifty-five died due to HF. In models accounting for age and other covariates, the RR for HF comparing the top quintile of 18?:?3n-3 (median 1·50?g/d) with the bottom quintile (median 0·88?g/d) was 0·91 (95?% CI 0·71, 1·17, P trend?=?0·41). The RR comparing the top quintile of 18?:?2n-6 (median 7·8?g/d) with the bottom quintile (median 4·6?g/d) was 1·14 (95?% CI 0·88, 1·46, P trend?=?0·36). We did not find evidence for the interaction of 18?:?3n-3 and 18?:?2n-6 with each other or with long-chain n-3 fatty acids. In conclusion, these data do not support our hypothesis that 18?:?3n-3 and 18?:?2n-6 are associated with HF. However, these results may not be generalisable to populations with higher intakes of 18?:?3n-3.     

Long-chain omega-3 polyunsaturated fatty acids and risk of stroke: a meta-analysis

Prospective studies of long-chain omega-3 polyunsaturated fatty acids (PUFA) in relation to stroke have yielded inconsistent results. The authors conducted a meta-analysis of prospective studies to summarize available evidence regarding the relation between long-chain omega-3 PUFA intake and stroke. Pertinent studies were identified by searching PubMed and Embase databases to November 1, 2012 and by reviewing the reference lists of relevant publications. Prospective studies that provided relative risks (RRs) with 95 % confidence intervals (CIs) for the association between dietary long-chain omega-3 PUFA intake and stroke were eligible. A random-effects model was used to combine study-specific results. Eight prospective studies, with 5238 stroke events among 242,076 participants, were included in the meta-analysis. The combined RR of total stroke was 0.90 (95 % CI, 0.81–1.01) for the highest versus lowest category of long-chain omega-3 PUFA intake, without heterogeneity among studies (P = 0.32). Results were similar for ischemic (RR, 0.82; 95 % CI, 0.71–0.94) and hemorrhagic stroke (RR, 0.80; 95 % CI, 0.55–1.15). A statistically significant reduction in total stroke risk was observed in women (RR, 0.80; 95 % CI, 0.65–0.99). This meta-analysis showed no overall association between omega-3 PUFA intake and stroke, but suggests that women might benefit from a higher intake of these PUFAs.     

Plasma leptin and prognosis in patients with established coronary atherosclerosis

OBJECTIVES: This study was designed to evaluate the relationship between plasma leptin and prognosis in patients with angiographically confirmed coronary atherosclerosis. BACKGROUND: Experimental studies suggest that leptin, an adipose tissue-derived hormone, exerts important cardiovascular effects. METHODS: Study subjects were recruited prospectively from a cohort of patients undergoing clinically indicated coronary angiography (n = 382). The median duration of follow-up was four years. Follow-up information was available for 361 patients. RESULTS: The combined end point of cardiac death, myocardial infarction (MI), cerebrovascular accident, or re-vascularization occurred in 44 subjects. In the simple Cox model, leptin had a significant (p < 0.001) non-linear/cubic univariate relationship with the combined end point. Other variables associated with prognosis in the univariate analysis were body mass index (BMI), prior MI, insulin resistance, C-reactive protein (CRP), fibrinogen, and number of coronary vessels with >50% stenosis. A positive relationship between leptin and prognosis was also seen when leptin levels were split by quintiles, with a hazard ratio of 6.46 for the highest quintile. The only two variables significantly associated with the combined end point in the multivariate Cox model were leptin (p = 0.004) and number of coronary vessels with >50% stenosis (p < 0.001). A similar relationship between leptin and prognosis was observed when leptin was adjusted for BMI. CONCLUSIONS: In patients with angiographically confirmed coronary atherosclerosis, leptin is a novel predictor of future cardiovascular events independent of other risk factors, including lipid status and CRP.     

Plasma homocysteine in obstructive sleep apnoea.

AIMS: Whether increased homocysteine is one mechanism linking obstructive sleep apnoea (OSA) to cardiovascular abnormalities is unclear. We hypothesised that plasma homocysteine would be higher in OSA patients than in control subjects, would increase further during sleep, and decrease after treatment with continuous positive airway pressure (CPAP). METHODS AND RESULTS: For study A, homocysteine was measured in 22 OSA patients and 20 controls first before sleep, then after 5 h of untreated OSA, and then in the morning after CPAP treatment. Homocysteine was similar in the OSA and control subjects at all three time points, and declined overnight in both groups (P=0.0017, P=0.036, respectively). To further assess this diurnal variation, we studied plasma homocysteine under a full-night protocol in 10 OSA patients and 12 controls (study B). Homocysteine was measured before sleep, in the morning after sleep, and at noon. Results in both OSA and control groups showed an overnight decline in homocysteine which was reversed by noon (repeated measures ANOVA: OSA, P=0.04; controls, P=0.02). Study C showed that disturbed sleep did not affect homocysteine levels in normal subjects. CONCLUSION: There is a significant diurnal variation in plasma homocysteine, so that homocysteine is lower in the morning after waking. Neither OSA nor disturbed sleep elicit acute or chronic changes in homocysteine.