The efficacy of a highly occlusive formulation for dry lips

OBJECTIVE

Since skin on the lips has a lower water content in the stratum corneum (SC) and a higher transepidermal water loss (TEWL) value than skin on the cheek, the lips are usually very dry and rough areas. Therefore, a lip balm approach to increase occlusivity of the lips is generally used to reduce water loss. Although there have been reports of an improvement effect on lip roughness by specific care agents, differences in the effects due to the occlusivity of a formulation without a specific care agent have not been reported. The purpose of this study was to clarify the improvement effect on dryness and roughness of the lips by a highly occlusive formulation consisting of a combination of common oil and wax, not by a specific care agent.

METHODS

Twenty Japanese female subjects with normal skin (age range 20-39 years; mean 28.1) were enrolled in this study. A 4-week continuous use test was conducted using samples with low and high occlusivity. The degree of lip roughness and wrinkles was scored, the hollow index was assessed using ANTERA 3D images, and values of capacitance and TEWL were measured.

RESULTS

The hollow index was significantly correlated with both the appearance roughness score and the wrinkle score. The sample with high occlusivity showed significant improvement in the appearance roughness score, wrinkle score, the hollow index and capacitance of the SC. In a comparison between the groups of samples with different occlusive properties, a significant improvement effect in rough appearance was seen in subjects using the highly occlusive formulation.

CONCLUSION

The hollow index assessed by ANTERA 3D imaging allowed the objective evaluation of the improvement in appearance. In the case of continuous use of the highly occlusive formulation, an improvement of capacitance in the SC, which is most correlated with lip roughness, was obtained after 2 and 4 weeks. These results demonstrate for the first time that a highly occlusive formulation is effective in improving the roughness of the lips, and this effect is due to the difference in the occlusive property not by a specific care agent.

Effect of empagliflozin versus placebo on body composition in patients with acute myocardial infarction and type 2 diabetes mellitus: subgroup analysis of the EMBODY trial

Background

Prevention of heart failure is one of the most important challenges after acute myocardial infarction (AMI). The development of heart failure is closely associated with fluid balance which can be evaluated by the measurement of body composition such as total body water (TBW), extracellular water (ECW), and intracellular water (ICW). This subgroup analysis of the EMBODY trial was designed to determine whether the Sodium–glucose cotransporter 2 (SGLT2) inhibitor affect fluid balance and improve heart failure in patients after AMI.

Methods

The EMBODY trial was a prospective, multicenter, randomized, double-blind, placebo-controlled trial in patients with AMI and type 2 diabetes in Japan. A total of 105 patients were randomized (1:1) to receive once-daily 10 mg empagliflozin, an SGLT2 inhibitor or placebo 2 weeks after the onset of AMI. In this subanalysis, we investigated the time-course of body composition measured by a bioelectrical impedance analyzer “InBody®”. The primary endpoints were changes in every particular parameter of body composition at week 0, 4, 12, and 24. Secondary endpoints were changes in blood pressure (BP), body weight and N-terminal pro b-type natriuretic peptide (NT-proBNP).

Results

Overall, 55 patients were included in the full analysis set (67.2±10.0 years, male 78.2%, and n=30 in empagliflozin group and 25 in placebo group). Baseline characteristics were not significantly different between the two groups. The change between at baseline and 24 weeks in TBW was −0.44 L (P=0.19) in the empagliflozin group and +1.14 L (P=0.0002) in the placebo group, adjusted difference −1.58 L, 95% confidence interval (CI) −2.46 to −0.70 L (P=0.0006). The empagliflozin group showed significant decreases in the body weight, ECW, ICW and systolic BP compared with the placebo group (−2.2 kg vs, +0.01 kg, P=0.004, −0.21 L vs, +0.40 L, P=0.001, −0.23 L vs, +0.74 L, P=0.0007, and −11.0 mmHg vs, +5.0 mmHg, P<0.0001, respectively). On the other hand, NT-Pro BNP levels significantly decreased in the empagliflozin group and placebo group (1028.7 pg/mL to 370.3 pg/ml, p=0.0001 and 1270.6 pg/mL to 673.7 pg/ml, p=0.006, respectively). In the multiple regression analysis of the change in TBW and ICW for the empagliflozin group, systolic BP was identified as a significant factor (P=0.001, and 0.003, respectively). In stratified analysis of BMI 25 kg/m2 or more, the empagliflozin group showed significant decreases in body weight, TBW, ECW and ICW compared with the placebo group, but not below BMI 25 kg/m2 group.

Conclusion

Empagliflozin reduced not only body weight, but also TBW, ECW and ICW. Interestingly, this tendency was remarkable at BMI 25 or more. This study suggested that early SGLT2 inhibitor administration in obesity patients with AMI and DM might be effective to reduce body weight and TBW.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Boehringer Ingelheim

Sex-related differences in clinical features and in-hospital outcomes of acute aortic dissection type b

Background

Acute aortic dissection (AAD) is a life-threatening medical condition with high morbidity and mortality. The association between female sex and poorer outcomes following surgery for AAD type A has been reported; however, the sex-related differences in clinical features and in-hospital outcomes of AAD type B remain to be elucidated.

Methods

We studied a total of 1877 patients with AAD type B who were enrolled in the Tokyo Acute Aortic Super-network from January 2013 to December 2016. Clinical features and in-hospital outcomes were compared between sexes. Independent predictors of in-hospital mortality were assessed using a multivariable analysis.

Results

The mean age of the patients was 69±13 years and 549 (29%) were females. Female patients were older than males (74±13 years vs 67±13 years; p<0.001). Females had lower systolic blood pressure on admission (158±37 mmHg vs 164±38 mmHg; p=0.007) and were more likely to have altered consciousness level at presentation (8.7% vs 3.9%; p<0.001), intramural hematoma (IMH)-type AAD (62.7% vs 53.6%; p<0.001), and DeBakey type IIIa (28.4% vs 21.8%; p=0.002) compared with males. Females were treated with medical therapy alone more frequently (90.3% vs 85.9%; p=0.009) and had a higher in-hospital mortality rate (5.3% vs 2.6%; p=0.036). A multivariable analysis revealed that age [per year, odds ratio (OR) 1.06; 95% CI 1.04–1.09; p<0.001], altered consciousness level (OR 3.28; 95% CI 1.54–6.98; p=0.002), shock/hypotension (OR 14.0; 95% CI 5.92–33.1; p<0.001), classic-type AAD (OR 2.54; 95% CI 1.36–4.73; p=0.003), and medical therapy alone (OR 0.28; 95% CI 0.15–0.54; p<0.001) were independent predictors of in-hospital mortality, whereas female sex was not predictive of in-hospital mortality (OR 1.64; 95% CI 0.91–2.96; p=0.10).

Conclusion

In AAD type B, females were older and had altered consciousness level, IMH-type, and a less widespread dissection more frequently than males. The overall in-hospital mortality was higher in females; however, female sex was not associated with in-hospital mortality after multivariable adjustment.

Funding Acknowledgement

Type of funding source: None

Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

 

Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment.

The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database.

We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded.

We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively.

In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain.

Funding Acknowledgement

Type of funding source: None

Relationship between age and the impact of revascularization on mortality in patients with non-ST-elevation myocardial infarction

Background

It is known that the early coronary revascularization in patients with non-ST-elevation myocardial infarction (NSTEMI) was associated with favorable clinical outcomes. However, it is still unclear whether this efficacy is equivalent over all the ages of the patients.

Methods

Patients with NSTEMI were screened from the database of the Tokyo CCU network registry. Of those, the patients treated without revascularization (medical treatment) were matched with the patients receiving revascularization by propensity score matching. The probabilities of in-hospital death were calculated in the logistic regression model. In two subgroups stratified according to median of the age (elderly and non-elderly subgroups), the odds ratios of revascularization for in-hospital death were calculated.

Results

In the patients registered between 2013 and 2017, 4,851 patients with NSTEMI were identified. After the screening, 370 patients with medical treatment were matched with 370 patients treated with revascularization. The incidence of in-hospital death was significantly higher in the patients with medical treatment (20.3% vs 13.0%, P=0.01). The two probability curves of in-hospital death in patients with and without revascularization converged as age increased. In the elderly subgroup, the revascularization was not significantly associated with favorable outcome of mortality, whereas it had a significant impact on mortality in the non-elderly subgroup (odds ratio: 0.47 [95% CI 0.23–0.95]).

Conclusion

The impact of revascularization on short-term mortality in patients with NSTEMI tended to be reduced as age increased.

Funding Acknowledgement

Type of funding source: None

Gender differences in patterns of relationship between body mass index and AF incidence

Background

Obesity is reportedly associated with the new incidence of atrial fibrillation (AF). However, gender differences in patterns of relationship between body mass index (BMI) and the risk of AF are unknown.

Methods

We analyzed 21,382 middle-aged Japanese subjects (10923 men, 10459 women) without AF from a cohort of employees undergoing annual health examinations, with a follow-up period of 4.8±3.7 years. We examined the relationship between BMI at baseline to AF incidence in unadjusted and adjusted analyses. This relationship was also studied using linear and quadratic models.

Results

AF had developed in 137 subjects (119 men; mean age, 54.4±8.2 years; incidence, 2.19 and 0.38 per 1000 person-years in men and women, respectively). In multivariable Cox proportional-hazard models, increasing age (hazard ratio [HR], 2.72 per year; 95% CI, 2.22 to 3.33; P<0.001), male gender (HR, 3.28; 95% CI, 1.86 to 5.76; P<0.001) and BMI (HR, 1.08; 95% CI, 1.02 to 1.15; P=0.007) were associated with the new incidence of AF in all cohorts. The shape of the BMI-incident AF relationship showed a linear association in women and a J-shaped association in men. (Figure) In particular, a U-shaped relationship was observed in young men aged 40–49, with increased risk among those with higher BMI and with very low BMI. In analyses adjusted for comorbidities and risk factors for CV disease, the U-shaped AF incidence versus BMI curves were not attenuated, suggesting that other genetic or congenital factors may mediate this relationship.

Conclusion

Our results indicate that the shape of the BMI-incident AF relation differs by sex and in particular a U-shaped relationship was observed in young men.

Patterns of relation among BMI and AF

Funding Acknowledgement

Type of funding source: None

Predictors of in-hospital mortality in patients with acute myocardial infarction due to unprotected left main trunk lesion: insight from the Tokyo Cardiovascular Care Unit network multicenter registry

Background

Acute myocardial infarction (AMI) due to unprotected left main trunk (LMT) lesion remains a clinical challenge because it requires prompt and efficient revascularization in catastrophic clinical presentation. However, predictors of in-hospital prognosis in patients with LMT-AMI are still not fully understood.

Purpose

To examine the predictors of in-hospital mortality in patients with LMT-AMI.

Methods

From 20,257 AMI patients in the Tokyo Cardiovascular Care Unit network registry (comprising 72 hospitals) from 2013 to 2017, we identified 371 (1.8%) eligible LMT-AMI patients without a history of coronary artery bypass grafting (CABG) and divided them into two groups: 254 survivors and 117 non-survivors. Measured variables included patient demographics, vital signs, laboratory data on admission, and in-hospital treatment. The outcome was in-hospital mortality. We performed a multivariable logistic regression analysis for in-hospital mortality with adjustment for the following 9 potential confounders, based on previous studies: (1) age, (2) sex, (3) Killip class, (4) ST elevation, (5) wide QRS (>120 msec), (6) the Thrombolysis in Myocardial Infarction (TIMI) grade on initial coronary angiography, (7) number of vessels with significant stenosis other than LMT, (8) renal dysfunction on admission, and (9) plasma glucose on admission.

Results

Overall, mean age was 70.6±11.8 years and 81.9% were male. ST-elevation myocardial infarction accounted for 61.8%. Cardiac arrest was observed in 102 (33.6%) patients. Percutaneous coronary intervention and CABG were performed in 302 (81.8%) and 63 (17.0%) patients, respectively. Intra-aortic balloon pumping and veno-arterial extracorporeal membranous oxygenation were used in 288 (77.8%) and 81 (21.9%) patients, respectively. In-hospital mortality was 31.5%. Multivariable logistic regression analysis showed that higher in-hospital mortality was significantly associated with Killip class IV (adjusted odds ratio 3.41 [95% confidence interval 1.36–8.56]; reference: Killip I), TIMI grade 0 (3.51 [1.22–10.14]; reference: TIMI grade 3), renal dysfunction (estimated glomerular filtration <60 mL/min/1.73m2; 6.48 [2.53–16.57]), and high plasma glucose on admission (>150 mg/dl; 3.64 [1.33–9.97]). Age, sex, ST-elevation, wide QRS, and multi-vessel disease were not significantly associated with in-hospital mortality.

Conclusions

LMT-AMI remains life-threatening in the current era of widely available revascularization. Our results showed that haemodynamic compromise, no coronary flow, renal dysfunction, and high plasma glucose on admission were strong predictors of in-hospital mortality after LMT-AMI. Given the high cardiac arrest rate, more aggressive therapeutic measures including mechanical circulatory support may be required to improve the prognosis of LMT-AMI.

Funding Acknowledgement

Type of funding source: None

Effect of air pollution on acute heart failure hospitalization differ across specific heart failure populations

Introduction

Several report showed the association between ambient air pollution including particular matter under 2.5um (PM2.5) and increasing rate of hospitalization for heart failure. However, these report analyzed mainly cross-sectional, epidemiological data, thus the reports regarding association between vulnerability to PM2.5 and specific populations in acute heart failure (AHF) were scarce.

Purpose

1. To analyze the association between air pollution and rate of hospitalization for AHF

2. To analyze whether the vulnerability to air pollution differ between specific populations in AHF. Methods

A case-cross over analysis was conducted to 4980 consecutive patients registered for multicenter acute heart failure registry in 2017 in our city Japan. This registry enrolled patients transferred to cardiovascular care unit (80 institutions) via emergency medical services across our city area. Logistic regression analysis were conducted to estimate percentage changes in the rate of acute heart failure hospitalization associated with per 1μg/m3 PM2.5 concentration increase. We also conducted subgroup analysis for patients stratified by age, gender, comorbidities, left ventricular ejection fraction, and clinical scenario.

Results

An increase in 1 μg/m3 PM2.5 concentration corresponded to 2.9% (95% CI 1.2–4.6%) increase in AHF hospitalization. Patients with age younger than 75, without prior heart failure hospitalization, without history of hypertension, without anemia, and with reduced ejection fraction were more susceptible to increase in PM2.5 concentration (Figure).

Conclusions

Increase in PM2.5 concentration was associated with increased rate of AHF hospitalization. Effect of PM2.5 may differ across specific AHF subpopulations.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Tokyo Metropolitan Government

The impact of low diastolic blood pressure on 30-day mortality of patients with acute myocardial infarction

Background

It is known that low diastolic blood pressure (DBP) is associated with long-term cardiovascular events after acute myocardial infarction (AMI). However, the impact of low diastolic blood pressure on short-term outcome has not yet been well investigated.

Methods and results

We included 15,208 patients who were hospitalized for AMI and registered in the Tokyo CCU network registry between 2013 and 2016. Thirty-day in-hospital mortality rate was 4.8% (728/15,208). To assess the relationship between DBP at the time of admission and 30-day mortality non-linearly, spline regression model was applied with the stratification of the cohort according to tercile of systolic blood pressure (SBP, low:≤122 mmHg, intermediate:123–148 mmHg, high:≥149 mmHg) and J-curve phenomenon was observed in the low and high SBP groups. In multivariate logistic regression analysis, adjusted odds ratio of the lowest quintile of DBP (≤64 mmHg) was 1.65 (95% CI:1.02–2.66) in low SBP group and 4.55 (95% CI:1.72–12.00) in high SBP group.

Conclusion

Low DBP was associated with increased 30-day in-hospital mortality rate after AMI even in patients with high SBP.

Funding Acknowledgement

Type of funding source: None

The suppressive effect on CD4 T cell alloresponse against endothelial HLA-DR via PD-L1 induced by anti-A/B ligation

While donor-specific human leukocyte antigen (HLA) antibodies are a frequent cause for chronic antibody-mediated rejection in organ transplantation, this is not the case for antibodies targeting blood group antigens, as ABO-incompatible (ABO-I) organ transplantation has been associated with a favorable graft outcome. Here, we explored the role of CD4 T cell-mediated alloresponses against endothelial HLA-D-related (DR) in the presence of anti-HLA class I or anti-A/B antibodies. CD4 T cells, notably CD45RA-memory CD4 T cells, undergo extensive proliferation in response to endothelial HLA-DR. The CD4 T cell proliferative response was enhanced in the presence of anti-HLA class I, but attenuated in the presence of anti-A/B antibodies. Microarray analysis and molecular profiling demonstrated that the expression of CD274 programmed cell death ligand 1 (PD-L1) increased in response to anti-A/B ligation-mediated extracellular signal-regulated kinase (ERK) inactivation in endothelial cells that were detected even in the presence of interferon-γ stimulation. Anti-PD-1 antibody enhanced CD4 T cell proliferation, and blocked the suppressive effect of the anti-A/B antibodies. Educated CD25⁺ CD127^- regulatory T cells (edu.T_regs ) were more effective at preventing CD4 T cell alloresponses to endothelial cells compared with naive T_reg ; anti-A/B antibodies were not involved in the T_reg -mediated events. Finally, amplified expression of transcript encoding PD-L1 was observed in biopsy samples from ABO-I renal transplants when compared with those from ABO-identical/compatible transplants. Taken together, our findings identified a possible factor that might prevent graft rejection and thus contribute to a favorable outcome in ABO-I renal transplantation.

Phase I/II study of adding intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis

BACKGROUND

Intraperitoneal chemotherapy using paclitaxel is considered an experimental approach for treating peritoneal carcinomatosis. This study aimed to determine the recommended dose, and to evaluate the clinical efficacy and safety, of the combination of intravenous gemcitabine, intravenous nab-paclitaxel and intraperitoneal paclitaxel in patients with pancreatic cancer and peritoneal metastasis.

METHODS

The frequencies of dose-limiting toxicities were evaluated, and the recommended dose was determined in phase I. The primary endpoint of the phase II analysis was overall survival rate at 1 year. Secondary endpoints were antitumour effects, symptom-relieving effects, safety and overall survival.

RESULTS

The recommended doses of intravenous gemcitabine, intravenous nab-paclitaxel and intraperitoneal paclitaxel were 800, 75 and 20 mg/m² respectively. Among 46 patients enrolled in phase II, the median time to treatment failure was 6·0 (range 0-22·6) months. The response and disease control rates were 21 of 43 and 41 of 43 respectively. Ascites disappeared in 12 of 30 patients, and cytology became negative in 18 of 46. The median survival time was 14·5 months, and the 1-year overall survival rate was 61 per cent. Conversion surgery was performed in eight of 46 patients, and those who underwent resection survived significantly longer than those who were not treated surgically (median survival not reached versus 12·4 months). Grade 3-4 haematological toxicities developed in 35 of 46 patients, whereas non-haematological adverse events occurred in seven patients.

CONCLUSION

Adding intraperitoneal paclitaxel had clinical efficacy with acceptable tolerability.