Geriatric nutritional risk index (GNRI) predicts long-term survival and limb events in patients with peripheral artery disease

Background

Geriatric nutritional risk index (GNRI) was developed as a “nutrition-related” risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality.

Purpose

The purpose of this study was to assess the associations of GNRI with mortality and amputation free survival in patients with peripheral artery disease (PAD).

Methods

From January 2011 to June 2016, 295 consecutive patients (73.3±9.2 years; 75.6% male) with PAD undergoing endovascular treatment (EVT) in our hospital were retrospectively examined. The GNRI on admission was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × body mass index (BMI)/22. Characteristics and mortality were compared between 2 groups: low GNRI (<92, n=110) with moderate or severe nutritional risk; and high GNRI (≥92, n=185) with no or low nutritional risk.

Results

The median follow up period was 39.4±26.4months. There were 85 deaths (28.8%) and 13 major amputation (4.4%) during the follow-up. Patients in the low-GNRI group were more often higher age, non-ambulatory state, hemodialysis and critical limb ischemia. BMI, serum hemoglobin, albumin, low-density lipoprotein were significantly lower, whereas serum C-reactive protein was significantly higher in the low-GNRI group than the high-GNRI group (P<0.05, respectively). Kaplan–Meier analysis revealed that patients in the low-GNRI group had a significantly lower amputation free survival, compared to those in the high-GNRI group (log-rank test, P<0.001).

Conclusion

The low GNRI is associated with an increased risk of mortality and limb events in patients with PAD.

Amputation-free survival (Kaplan-Meier)

Funding Acknowledgement

Type of funding source: None

Survival of people living with AIDS with or without tuberculosis in Sao Paulo, Brazil

Background

To estimate median survival time of AIDS patients, with and without tuberculosis (TB), in a cohort in Sao Paulo, Brazil, and to investigate survival predictors.

Methods

Retrospective cohort study of AIDS patients above 12 years old, registered at the Ministry of Health AIDS surveillance system between 2003-2007, and followed until 2014. Survival analysis used the Kaplan-Meier method and Cox proportional hazards model to estimate hazard ratios (HR), with respective 95% confidence intervals (CI = 95%).

Results

35,515 patients were included, being 4,581 (12.9%) co-infected with TB. Among the latter, probability of survival 12 years after AIDS diagnosis was 95.2%, 82.9%, and 21.9%, respectively for patients receiving at least one third line ARV (HAART2), receiving triple therapy (HAART1) and the last one not on ARV. In the same period, the probability of survival for patients without TB, in the same order as for the therapeutic regimens, was 95.2%, 90.5%, and 40.9%, respectively. The main factors associated with survival, adjusted for the year of diagnosis, were: Living in the city of Sao Paulo (HR = 1,16;IC95% 1,01-1,32), living away from the capital city (HR = 1.43; 95%CI 1.25-1.62); or on the coast (HR = 1.49; 95%CI 1.21-1.82); having TB (HR = 1.70; 95%CI 1.49-1.87); above 49 years old (HR = 1.35; 95%CI 1.18-1.54); black (HR = 1.27; 95%CI 1.12-1.45); IV drug use (HR = 1.73; 95%CI 1.49-2.02); CD4+ below 200 cell/mm³ at AIDS diagnosis (HR = 2.31; 95%CI 1.97-2.72); viral load above 500 copies at AIDS diagnosis (HR = 1.99; 95%CI 1.72-2.30); HAART1 scheme (HR = 1.94; 95%CI 1.47-2.55); no ARV (HR = 8.22; 95%CI 2.95-22.87).

Conclusions

A large proportion of patients did not receive ARVs or were late diagnosed with AIDS, especially those with TB, whose survival was shorter. Survival is heterogeneous in the state, being lower in regions with higher TB rates. The results point to the need for specific strategies for patients with TB-HIV co-infection.

Key messages

Tuberculosis is the main cause of death among HIV-infected people, being responsible for one third of deaths in this group and causing a great impact on the survival of this population. The Brazilian policy of universal access to ARV and treatment for TB has increased the survival of AIDS-TB from 22% to 95% and in patients without TB from 50% to 95% up to 12 years after diagnosis.

P179 Alterations of resting heart rate and heart rate viability after cryoballon ablation in the patients with paroxysmal atrial fibrillation

Background

While it is generally accepted that cardiac autonomic nervous system (CANS) plays an important role in atrial fibrillation (AF) and pulmonary vein isolation (PVI) by radiofrequency catheter ablation modifies the ganglionated plexi (GP), the alterations of CANS after PVI are not clarified.

Purpose

The objective of this study was to investigate the alteration of CANS after conventional cryoballoon ablation (CBA) by using a non-invasive examination method of measuring resting heart rate (R-HR) and coefficient of variation of R-R interval (CVR-R) which is a representative parameter of heart rate viability. CVR-R reflects R-R interval variation affected by respiration. It is calculated from the R-R interval of consecutive 100 heart beats of sinus rhythm recorded at rest. Declines of CVR-R indicate the parasympathetic dysfunction and the normal range of it varies depend on the age. As age increases from 30s to 70s, the average value of CVR-R decreases from 4.0% to 2.4%.

Methods

Consecutive patients of paroxysmal AF treated with initial CBA in our institute participated. Subjects were limited to the patients who maintained sinus rhythm through the study and whose prescription had not been changed after procedure. All patients recorded 12-lead electrocardiogram to measure R-HR and CVR-R before and the day after the procedure. We compared R-HR and CVR-R of all patients before and after CBA. And in addition, we compared them in each of two groups whose pre-procedural H-RH were under 50 bpm (Group-U50) and over 70 bpm (Group-O70). All procedures were performed with second generation 28mm cryoballoon (CB)s under the conscious sedation with Dexmedetomidine. CB temperature was down to a minimum of -60°C and target application time was 180 seconds.

Results

In the procedure of all 105 patients (male gender, 54%; age, 66.9 ± 10.4years; CHADS2score, 1.15 ± 1.04; diabetes mellitus,14%; beta-blocker therapy, 16%), 1 of touch-up for PVI, 6 of supra vena cava isolation and 21 of cavotricuspid isthmus linear ablations with radiofrequency catheter were added. In all patients, R-HR increased from 58.9 ± 9.2bpm to 72.4 ± 9.5bpm (P < 0.01) and CVR-R decreased from 2.36 ± 1.08% to 1.24 ± 0.68% (P < 0.01), respectively. In Group-U50 (n = 14; male gender 64%; age 67.6 ± 12.4 years), R-HR increased from 47.1 ± 2.1bpm to 64.4 ± 7.9bpm (P < 0.01) and CVR-R decreased from 2.58 ± 1.59% to 1.34 ± 0.82% (P < 0.01), respectively. In Group-O70 (n = 17; male gender 43%; age 67.4 ± 12.6 years), R-HR increased from 73.7 ± 2.8bpm to 81.8 ± 7.4bpm (P < 0.01) and CVR-R decreased from 2.33 ± 0.94% to 1.14 ± 0.52% (P < 0.01), respectively. Values of CVR-R before and after CBA showed no significant difference between the two groups.

Conclusions

After CBA, R-HR increment and CVR-R decrement were significantly observed. CVR-R was halved regardless of pre–procedural R-HR. Damages to GP by CBA would be reflected as denervation of vagus nerves in CANS. R-HR increase might be associated with parasympathetic suppression of CANS.

P1917Can cryoballoon ablation produce alterations in cardiac and extra-cardiac autonomic nervous system in patients with atrial fibrillation?

Background

Cryoballoon ablation (CBA) during pulmonary vein isolation (PVI) for atrial fibrillation (AF) can cause direct thermal injury to structures adjacent to the left atrium, including the periatrial ganglionated plexi (GP). In contrast, it has not been clarified whether cardiac autonomic nervous system (CANS) modification by CBA could indirectly affect extra-CANS.

Purpose

This study was aimed to investigate the impact of CBA on extra-CANS as well as CANS in AF patients.

Methods

Ninety-three Consecutive patients who underwent initial CBA in our institute were enrolled. Among them, 64 subjects (age 67±9 years; male gender 52%; CHADS2 score 1.2±1.0; diabetes mellitus 16%; β-blocker therapy 23%) had paroxysmal AF (G-P) and 29 (age 66±7 years; male gender 90%; CHADS2 score 1.3±1.0; diabetes mellitus 24%; β-blocker therapy 34%) had sustained AF (G-S). In G-P, resting sinus heart rate (R-HR) and coefficient of variation of the R-R intervals (CVR-R) during sinus rhythm were measured in resting 12-lead electrocardiogram before and after CBA as an index of CANS. Decrease in CVR-R after PVI reflects the vagal nerve injury by the procedure. Pupil movement reflects the autonomic nervous function. In both groups, pupillary light reflex, as an indicator of extra-CANS activity, was measured by infrared videopupillography (Iriscorder® Dual C10641, Hamamatsu Photonics, Hamamatsu, Japan) before and after CBA. Velocity of dilatation (VD) is related to sympathetic function, and velocity of contraction (VC) is associated with the balance between sympathetic and vagal tone. All CBA were treated with second generation 28mm cryoballoons (CB). CB temperature was down to a minimum of −60°C and target application time was 180 seconds.

Results

Complete PVI was achieved in all patients, in which touch-up radiofrequency ablation for the PVI was required in 4 cases of G-S. In G-P, R-HR significantly increased (59.2±9.2bpm to 72.5±8.3bpm, p<0.01) and CVR-R significantly decreased (2.32±1.1% to 1.61±0.61%, p<0.01) after CBA, while VC and VD did not significantly change (3.83±1.03mm2/sec to 3.64±0.96mm2/sec and 1.83±0.62mm2/sec to 1.86±0.84mm2/sec, respectively). In G-S, there were not significant changes between before and after CBA in VC and VD (3.77±0.80mm2/sec to 3.71±0.99mm2/sec and 1.81±0.49mm2/sec to 1.80±0.59mm2/sec, respectively). There were no significant differences between two groups in VC and VD before the procedure.

Conclusion

These results suggest that CBA seems to result in local parasympathetic denervation due to damage of adjacent structures including ganglionated plexi while the alteration of CANS by CBA does not seem to efferently affect extra-CANS.

Non-thermal ablation of expanded polytetrafluoroethylene with an intense femtosecond-pulse laser

Ablation of expanded polytetrafluoroethylene without disruption of the fine porous structure is demonstrated using an intense femtosecond-pulse laser. As a result of laser-matter interactions near ablation threshold fluence, high-energy ions are emitted, which cannot be produced by thermal dissociation of the molecules. The ion energy is produced by Coulomb explosion of the elements of (-CF(2)-CF(2)-)(n) and the energy spectra of the ions show contributions from the Coulomb explosions of the ions rather than those of thermal expansion to generate high-energy ions. The dependence of ion energy on the laser fluence of a 180-fs pulse, compared with that of a 400-ps pulse, also suggests that the high-energy ions are accelerated by Coulomb explosion.

Ion generation in a low-density plastic foam by interaction with intense femtosecond laser pulses

Energetic proton generation in low-density plastic (C5H10) foam by intense femtosecond laser pulse irradiation has been studied experimentally and numerically. Plastic foam was successfully produced by a sol-gel method, achieving an average density of 10 mg/cm(3). The foam target was irradiated by 100 fs pulses of a laser intensity 1 x 10(18) W/cm(2). A plateau structure extending up to 200 keV was observed in the energy distribution of protons generated from the foam target, with the plateau shape well explained by Coulomb explosion of lamella in the foam. The laser-foam interaction and ion generation were studied qualitatively by two-dimensional particle-in-cell simulations, which indicated that energetic protons are mainly generated by the Coulomb explosion. From the results, the efficiency of energetic ion generation in a low-density foam target by Coulomb explosion is expected to be higher than in a gas-cluster target.

Proposed double-layer target for the generation of high-quality laser-accelerated ion beams

In order to achieve a high-quality, i.e., monoenergetic, intense ion beam, we propose the use of a double-layer target. The first layer, at the target front, consists of high-Z atoms, while the second (rear) layer is a thin coating of low-Z atoms. The generation of high-quality proton beams from the double-layer target, irradiated by an ultraintense laser pulse, is demonstrated with three-dimensional particle-in-cell simulations.

Study on optimal fat content in total parenteral nutrition in partially hepatectomized rats

In order to investigate the optimal fat content for total parenteral nutrition (TPN) solutions, male Wistar rats were subjected to 70% hepatectomy and then placed, for five days, on one of five TPN regimens in which fat represented 0%, 10%, 20%, 30% and 40%, respectively, of the total calorie content. As serum triglyceride levels in the fat-treated groups were lower than those in the non-treated normal rats, it was concluded that the administered fat was sufficiently hydrolyzed. The greater the fat content, the higher the regeneration rate of the remnant liver. Significant differences were found between the 0%-fat group and 20%-plus fat groups. Hepatic triglyceride level was significantly lower in the 20%-fat group. Hepatic protein level was significantly elevated in all fat-treated groups. Serum phospholipids and total cholesterol due to the lecithin contained in fat emulsion were significantly elevated in the 30 and 40%-fat groups, indicating that fat content of 30 and 40% was excessive. The results suggest that TPN containing fat is superior to fat-free TPN for liver regeneration after partial hepatectomy, and that optimal fat content is estimated to be about 20% of total calorie content in the case of this fat emulsion.

Some pungent principles of spices cause the adrenal medulla to secrete catecholamine in anesthetized rats

We recently reported that capsaicin, a pungent principle of hot red pepper, evokes catecholamine secretion from the rat adrenal medulla. In this study, the effects of some pungent principles of spices on adrenal catecholamine secretion were investigated as compared with that of capsaicin. An increase in catecholamine, especially epinephrine, secretion was observed not only on capsaicin infusion but also on piperine (a pungent principle of pepper) and zingerone (ginger) infusion. Even on infusion of the same amount (650 nmol/kg, i.v.), the order of potency as to catecholamine secretion was capsaicin much greater than piperine greater than or equal to zingerone. While, sulfur-containing and volatile pungent principles, allylisothiocyanate (mustard, etc.) and diallyldisulfide (garlic, etc.), did not even cause slight catecholamine secretion. Furthermore, these adrenergic secretagogues were readily transported via the gut into the body. These results indicate that some pungent principles of dietary spices can induce a warming action via adrenal catecholamine secretion.