In hospital mortality and outcomes of patients with acute decompensated diastolic heart failure with and without amyloidosis

Introduction

The incidence of heart failure has exponentially increased over the last few decades and acute decompensated diastolic heart failure is one of the leading causes of hospitalization and readmission. Cardiac amyloidosis is one of the rapidly progressing heart conditions. It occurs due to amorphous proteinaceous material called amyloid into the extracellular space of the heart. The infiltration of the heart from amyloid protein has a broad spectrum of presentation, including diastolic heart failure.

Purpose

Heart failure due to amyloidosis is characterized by diastolic dysfunction resulting from restrictive cardiomyopathy. The outcomes of hospitalized patient with acute decompensated diastolic heart failure in amyloidosis patients compared to those without amyloidosis is not well defined.

Methods

We conducted a retrospective cohort study by utilizing the National Inpatient sample database from 2017. Using International Classification of disease (ICD)-10 codes, patients with the diagnosis of acute and acute on chronic diastolic heart failure were enrolled in the study. They were further stratified based on the presence of amyloidosis. The primary outcome was to measure in-hospital mortality, while secondary outcomes included development of acute kidney injury (AKI), Acute respiratory failure (ARF), shock and arrhythmias.

Results

Out of the 915,694 patients with Acute Decompensated diastolic heart failure, about 2270 had amyloidosis as secondary diagnosis. 6.1% of ADHF and amyloidosis died in hospital, compared to 4.2% in those without amyloidosis (aOR=1.35 CI=0.89–2.05, p=0.197). On multivariate analysis, patients with Amyloidosis had increased odds of developing AKI (aOR=1.40 CI 1.13–1.72, p=0.001), Cardiogenic shock (aOR=2.67 CI 1.56–4.55, p<0.001) and arrhythmias (aOR=1.34, CI 1.10–1.64, p=0.004). The incidence of ARF was however lower in patients without amyloidosis compared to those with it (aOR=0.60, CI 0.47–0.75, p<0.001).

Conclusion

Amyloidosis is one of the underappreciated and underdiagnosed causes of heart failure. Our study shows an increased risk of complications in acute decompensated heart failure with the presence of amyloidosis. Thus, physicians must be aware of this clinical entity for early diagnosis as patients with advanced disease are likely to have poor prognoses.

Funding Acknowledgement

Type of funding sources: None.

Structural changes in popped sorghum starch and their impact on the rheological behavior

Sorghum has been used to expand snacks such as pop sorghum. However, it is still unknown how the structural changes during the popping affect its rheological and functional properties. This study evaluated the structural changes of popped sorghum starch (PS) and their impact on rheological behavior. Moisture sorghum was adjusted to 11, 15, and 20% before popped. Morphology, X-ray pattern (XRP), infrared spectra (IR), thermal properties, and rheological behavior before and after popping were evaluated. Micrographs showed a honeycomb-like structure in PS. XRP showed partial damage to the orthorhombic crystals of the sorghum starch after PS, while the growth of crystalline lamellae was also generated (13.08 and 20.01°). IR showed structural damage as the signal at 1045 cm^-1 disappeared in PS. The IM increased to gelatinization of the starch. The rheological behavior of PS displayed better thermal stability, with the lowest breakdown (25 ± 3.5 cP), setback (253 ± 11.3 cP), and final (1337 ± 5.7 cP) viscosity. The consistency coefficient k and flow behavior index n increase, meaning a loss of the pseudoplastic character. Viscoelastic properties increased in PS, suggesting the formation of cross-links and a stable matrix. Correlation analysis showed a strong relationship between structural changes and the rheological behavior of PS.

Evaluation of Neuropathy, Glycemic Control, and Revascularization as Risk Factors for Future Lower Extremity Amputation among Diabetic Patients

BACKGROUND

Diabetes mellitus is a major risk factor for progression to lower extremity amputation (LEA) due to progressive neuropathy and glycemia-induced vasculopathy. In this study, we evaluated risk factors for incident LEA type 2 diabetics during a randomized controlled trial and extended post-trial follow-up.

METHODS

The Action to Control Cardiovascular Risk in Diabetes trial randomized 10,251 type 2 diabetics to intensive glycemic control (Hemoglobin A1c (HbA1c) target <6.0%) versus standard glycemic control (HbA1c target 7.0-7.9%). Using backward elimination logistic regression models, we examined relationships between neuropathy using the Michigan Neuropathy Screening Instrument (MNSI) and glycemic control and incident LEA during the clinical trial and subsequent follow-up.

RESULTS

9,746 patients were followed for a mean of 7.9 +/-3.1 (median 8.9) years after randomization. Ninety-eight (1%) participants underwent an incident LEA during the trial or post-trial follow-up period. Baseline demographics and traditional risk factors were examined by incident amputation status. Multivariable models revealed that abnormal 10 gm filament test (HR 4.50, 95% CI 2.92-6.95, P < 0.0001), presence of ulceration (HR 4.22, 95% CI 1.65-10.8, P = 0.0004), abnormal appearance on foot examination (HR 4.75, 95% CI 2.30-9.83, P < 0.0001), and mean postrandomization HbA1c (HR 1.65, 95% CI 1.35-2.00, P < 0.0001) were strongly predictive of LEA when accounting for other common risk factors for amputation.

CONCLUSIONS

In this post hoc analysis of a large randomized controlled population of diabetic patients, we found that components of the MNSI score including presence of ulceration, abnormal appearance of the foot, and 10 gm filament monofilament scoring were strongly predictive of LEA. This adds a valuable clinical tool in the risk stratification of diabetic patients for LEA.

Precooling treatments induce resistance of Anastrepha ludens eggs to quarantine treatments of high-pressure processing combined with cold

High-pressure processing (HPP) combined with heat or cold has been proposed as an alternative quarantine process for Mexican fruit fly Anastrepha ludens Loew (Diptera: Tephritidae). HPP conditions at levels higher than 100 MPa applied to destroy eggs and larvae can also affect the postharvest physiology of the fruits. HPP at pressure levels in the range of 50-100 MPa is recommended. Eggs have been reported as being more resistant to HPP than larvae. Therefore, the objective of this study was to assess the effect of a precooling treatment on the biological viability of A. ludens eggs treated by HPP at 0 degrees C. The capability of nondestroyed eggs to develop and reproduce was also evaluated. One-, 2-, 3-, and 4-d-old eggs were precooled in ice water for 0 (control) 3, 6, 12, or 24 h and then pressurized at 50, 70, or 90 MPa for 0, 3, 6, or 9 min at 0 degrees C. The hatching capability of pressurized eggs was evaluated. The most lethal effect of HPP on nonprecooled eggs (0 h) was obtained at 90 MPa for 9 min, destroying all eggs except for the 3-d-old ones, which showed an 11.8% hatch rate. Precooling treatment improved the hatch rate of eggs ranging from 4 to 50% depending on precooling conditions. The main effect was observed after 6 h. These results suggest that precooling modified the biochemistry and physiology of eggs, improving their resistance to HPP treatments.

Quantitative Determination of Thermally Derived Off-Flavor Compounds in Milk Using Solid-Phase Microextraction and Gas Chromatography

Many volatile compounds generated during the thermal processing of milk have been associated with cooked, stale, and sulfurous notes in milk and are considered as off-flavor by most consumers. A headspace solid-phase microextraction (HS-SPME)/gas chromatographic technique for the quantitative analysis of thermally derived off-flavor compounds was developed in this study. The extraction temperature, time, and sample amount were optimized using a randomized 2(3) central composite rotatable design with 2 central replicates and 2 replicates in each factorial point along with response surface methodology. Calibration curves were constructed in milk using the standard addition technique, and then used to quantify 20 off-flavor compounds in raw, pasteurized, and UHT milk samples with various fat contents. The concentrations of these volatiles in raw and pasteurized milk samples were not significantly different. However, dimethyl sulfide, 2-hexanone, 2-heptanone, 2-nonanone, 2-undecanone, 2-methylpropanal, 3-methylbutanal, heptanal, and decanal were found at higher concentrations in UHT milk as compared with raw and pasteurized milk samples. In addition, the concentration of methyl ketones was greater in UHT milk with higher fat content. The calculated odor activity values suggested that 2,3-butanedione, 2-heptanone, 2-nonanone, 2-methylpropanal, 3-methylbutanal, nonanal, decanal, and dimethyl sulfide could be important contributors to the off-flavor of UHT milk. The HS-SPME technique developed in this study is accurate and relatively simple, and can be used for the quantification of thermally derived off-flavor compounds in milk.

Effect of Moderate Pressure Treatments on Microstructure, Texture, and Sensory Properties of Stirred-Curd Cheddar Shreds

A moderate high-pressure processing (HPP) treatment is proposed to accelerate the shredability of Cheddar cheese. High pressure processing (345 and 483 MPa for 3 and 7 min) applied to unripened (1 d old) stirred-curd Cheddar cheese yielded microstructure changes that differed with pressure level and processing time. Untreated and pressure-treated cheese shredded at d 27 and 1, respectively, shared similar visual and tactile sensory properties. The moderate (345 MPa) and the higher (483 MPa) pressure treatments reduced the presence of crumbles, increased mean shred particle length, improved length uniformity, and enhanced surface smoothness in shreds produced from unripened cheese. High-pressure processing treatments did not affect the mechanical properties of ripened cheese or the proteolytic susceptibility of milk protein. It was concluded that a moderate HPP treatment could allow processors to shred Cheddar cheese immediately after block cooling, reducing refrigerated storage costs, with expected savings of over 15 US dollars/1000 lb cheese, and allowing fewer steps in the handling of cheese blocks produced for shredding.

Reward and reinforcement produced by drinking water: role of opioids and dopamine receptor subtypes

The conditioned place preference procedure was used to evaluate the reinforcing properties of drinking in water-deprived rats. Subjects were allowed to drink for 8 min and were then transferred to place preference cages. In Experiment 1, the effects of naloxone and pimozide on drinking-induced place preference were analyzed. Animals treated with naloxone, 16 mg/kg, before the conditioning sessions showed a place aversion instead of the place preference found in saline-treated animals. Naloxone also reduced drinking. It was proposed that naloxone induced a state of frustrative nonreward. Pimozide, 1 mg/kg, blocked place preference and somewhat reduced drinking. In Experiment 2, doses of 1 and 4 mg/kg naloxone were used. Both doses blocked place preference. A dose of 4 mg/kg had a marginal effect on drinking, while 1 mg/kg lacked effect on this behavior. Thus, naloxone may block the establishment of place preference without modifying drinking. The effects of the dopamine D1 antagonist SCH23390 and the D2 antagonist raclopride were studied in Experiment 3. SCH23390 blocked place preference and reduced drinking at doses of 0.25 and 0.125 mg/kg. A dose of 0.06 mg/kg did not affect drinking but inhibited place preference. Raclopride, 0.25 mg/kg, had the same effects as SCH23390 at the same dose while 0.125 mg/kg blocked place preference without affecting drinking. It appears that the effects of a D1 and a D2 antagonist are similar. Because the effects of these latter drugs also are similar to those obtained with naloxone, it is suggested that both dopamine and opioids are important for water-induced reinforcement. Possible interactions between these two neurotransmitter systems are discussed.

Evaluation of a simple screening test for the quality of drinking water systems

A simple and inexpensive assay for detection of H2S producing bacteria in drinking water was evaluated in Paraguay. Using an improved preparation procedure, results were basically temperature independent in the range of 22-37 degrees C and correlated well with the presence of total coliform bacteria (96%, 28 degrees C). The assay was not suitable for control of surface water and dug well water due to the frequent presence of non-faecal coliforms. However, it was very suitable for routine control of high quality water systems, like treated community water systems or deep-tube well water, where complete absence of coliforms is required. The H2S-test is very inexpensive and does not require a laboratory technician or special equipment. Its use permits a cost-effective routine control of high quality community water systems in developing countries. In addition, this test turned out to be an effective educational tool for heightening the awareness of people towards dangers of unclean drinking water.

Cardiomyopathy in Cebus apella monkeys experimentally infected with Trypanosoma cruzi

Twenty four Cebus apella monkeys were studied as a biological model for the cardiac chronic form of Chagas' disease. Twelve were inoculated with Trypanosoma cruzi trypomastigotes, seven with the Brazilian Y strain and five with the Argentinian RA strain. Twelve monkeys were uninfected controls. The following parameters were studied: body weight, body temperature, direct parasitemia, xenodiagnosis, specific antibodies by IFA, clinical chemistry, hematology, ECG and chest X-ray. Three monkeys infected with Y strain were sacrificed at 4 months and 4 monkeys at 12 months after inoculation. Monkeys inoculated with RA strain were sacrificed at 48 months. Direct parasitemia was positive within a week after inoculation in all monkeys. Xenodiagnosis was positive until 49.0 +/- 3.0 and 79.0 +/- 6.0 weeks p.i. for Y and RA strains, respectively. In all inoculated monkeys an increase in antibody titers was detected within 3 weeks after inoculation. In all monkeys inoculated with the Y strain and 3/5 with the RA strain abnormal ECGs were observed within 1 or 2 weeks p.i., becoming more severe in the chronic phase. Y strain inoculated monkeys sacrificed at 4 months presented only a slight concentric hypertrophy of the heart left ventricle. Those sacrificed at 12 months had concentric left ventricle hypertrophy and 3/4 had an aneurism of the apex. Four out of 5 RA strain inoculated monkeys had an enlarged, flaccid heart; 3/5 aneurism of the apex and 2/5 concentric hypertrophy of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Seminal prolactin and its relationship to sperm motility in men

Semen assessment and levels of serum and seminal plasma prolactin (PRL) were determined in 81 men. In subjects with both normal sperm concentrations and normal sperm motility, the levels of serum and seminal plasma PRL were 14.7 +/- 1.48 and 10.0 +/- 1.05 ng/ml (mean +/- standard error of the mean, SEM, P less than 0.05), respectively. This difference is not observed either in subjects with polyzoospermia with normal sperm motility, or in those with oligozoospermia. Serum PRL was higher in azoospermia and also in subjects with lower levels of seminal citric acid. Seminal plasma PRL was directly related to sperm motility (r = 0.70, P less than 0.01) and inversely related to sperm concentration (r = -0.42 P less than 0.05). Seminal PRL was increased in subjects with higher levels of seminal citric acid and decreased in subjects with lower levels of corrected seminal fructose. Serum and seminal plasma PRL did not change significantly in subjects with different concentrations of serum testosterone.