Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures

This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20.

BACKGROUND

Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term.

OBJECTIVE

This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs.

METHODS

This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients' conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors.

RESULTS

The mean observation period was 4.0 years (range 0-7 years). The average age at the time of admission was 82 years (range 60-101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio [HR] 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82-91), low risk (92-98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (p < 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88 [p = 0.004]).

CONCLUSIONS

We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.

Peak oxygen uptake in cardiopulmonary exercise testing was associated with left ventricular diastolic dysfunction in patients with preserved ejection fraction

Background

Heart failure with preserved ejection fraction (EF) remains a poor prognosis as same as heart failure with reduced EF. Peak oxygen uptake (VO2) by cardiopulmonary exercise testing (CPET) is a useful parameter for predicting cardiovascular diseases prognosis. Furthermore, though there are some reports that CPET parameters are associated with indicators of diastolic dysfunction, each of these indicators has some limitations. Recently, recommendations for the evaluation of left ventricular diastolic function by echocardiography were reported from the ASE/EACVI. However, no reports have examined the association between exercise tolerance indices and diastolic dysfunction based on these recommended variables.

Purpose

To examine the relationship between peak VO2 and diastolic dysfunction using the recommendation from ASE/EACVI in cardiovascular diseases patients with preserved EF

Methods

We recruited 214 patients who were performed both CPX and echocardiography. EF ≥50% was 99 patients. All patients underwent 0W warm-up and 10W ramp on an upright electrical bicycle ergometer. Diastolic dysfunction was assessed using the recommendations for the evaluation of diastolic function by ASE/EACVI. We used abnormal cutoff values are annular e' velocity: septal e' &lt;7 cm/s, lateral e' &lt;10 cm/s, average E/e' ratio &gt;14, left atrial volume index &gt;34 ml/m2, and peak tricuspid regurgitation (TR) velocity &gt;2.8 m/s. Diastolic dysfunction is present if more than half of the available parameters meet these cutoff values.

Results

Mean age was 57±14 years old, the portion of women was 69%. The portion of diastolic dysfunction was 16%. In univariable logistic regression analysis, age, log BNP, septal e' &lt;7 cm/s or lateral e' &lt;10 cm/s, peak TR velocity &gt;2.8 m/s, and the presence of diastolic dysfunction were significantly associated with peakVO2 &lt;14 ml/min/kg. In multivariable logistic regression analysis, the presence of diastolic dysfunction was an independent risk factor for peak VO2 &lt;14 ml/min/kg (OR 5.03 CI 1.32–19.2, p=0.018). Furthermore, we investigated the association between each variable of diastolic dysfunction and peak VO2 and found that low septal and lateral e'velocity and high TR peak flow velocity were significantly associated with peak VO2 &lt;14 ml/min/kg.

Conclusions

In preserved EF, low peak VO2 was significantly associated with diastolic dysfunction assessed by the recommendations from the ASE/EACVI.

Funding Acknowledgement

Type of funding sources: None.

Association of cardiac prognosis in chronic limb-threatening ischemia patients after endovascular intervention and wound, ischemia, and foot infection clinical stage

Background

Chronic limb-threatening ischemia (CLTI) represents the end-stage manifestation of peripheral artery disease. Recently, the Society for Vascular Surgery established the Wound, Ischemia, and foot Infection (WIfI) classification system, focusing on disease severity rather than arterial lesion characteristics. While the WIfI clinical stage has been thought to have a prognostic value in CLTI patients, the hemodialysis and left ventricular ejection fraction (LVEF) also appear to represent pivotal factor affecting prognosis among CLTI patients. However, few reports have addressed associations between WIfI clinical stage and cardiac death.

Purpose

The purpose of this study was to investigate the patient's clinical factors including WIfI clinical stage and mortality of CLTI patients undergoing endovascular intervention based on WIfI clinical stage.

Methods

This retrospective study investigated 200 consecutive CLTI patients and we individually assessed WIfI clinical stage. We then compared mortality after endovascular intervention between a WIfI stage 1, 2 group and a stage 3, 4 group, and investigated associations between baseline characteristics and WIfI clinical stage 1, 2 group and a stage 3, 4 group.

Results

Among 200 patients, 123 patients (62%) showed WIfI stage 1 or 2, and the remaining 77 patients (38%) had WIfI stage 3 or 4. Age was significantly higher in the WIfI stage 3, 4 group [median 75, interquartile range (IQR) 68–82] compared with the WIfI stage 1, 2 group (median 70, IQR 63–79, p=0.004). The rate of diabetes mellitus patients was significantly higher in the WIfI stage 3, 4 group (62% vs. 82%, p=0.003), but no differences in the rate of hemodialysis between WIfI stage 3, 4 group and WIfI stage 1, 2 group (53% vs. 37%, p=0.056). Median duration of follow-up was 966 days (IQR, 540–1268 days). Forty patients (20%) died after endovascular intervention. Incidences of all-cause and cardiac deaths were higher in the WIfI stage 3, 4 group than in theWIfI stage 1, 2 group (27% vs. 15%, p=0.047 and 12% vs. 3%, p=0.040, respectively). Kaplan–Meier analysis showed a significantly lower survival rate in the WIfI stage 3, 4 group than in theWIfI stage 1, 2 group (p=0.002 by log-rank test). Cox proportional hazard univariate analysis revealed that WIfI stage 3 or 4 [odds ratio (OR) 4.22, 95% confidence interval (CI) 1.29–13.72, p=0.012), hemodialysis (OR 4.67, 95% CI 1.28–16.96, p=0.010), LVEF (OR 0.96, 95% CI 0.92–0.99, p=0.045) were correlated to cardiac death. Multivariate analysis models using relevant factors from univariate analysis showed only WIfI stage 3 or 4 [odds ratio (OR) 3.74, 95% confidence interval (CI) 1.08–12.87, p=0.028) was significantly associated with cardiac death.

Conclusion

These results indicate that CLTI patients with high WIfI clinical stage may be associated with poor cardiac prognosis after endovascular intervention.

Funding Acknowledgement

Type of funding sources: None.

Secondary rotational atherectomy strategy may reduce the occurrence of prolonged ST-segment elevation following ablation

Background

Rotational atherectomy (RA) has been widely used for severely calcified lesions in performing percutaneous coronary intervention (PCI). The slow flow phenomenon is the most frequently observed complication of RA and leads to prolonged ST-segment elevation. The incidence of the slow flow phenomenon was reported as approximately 5–20%. Several methods have been recommended to treat the slow flow phenomenon; however, the elevation of ST-segment may often persist after disappearance of slow flow phenomenon on angiography.

Purpose

The aim of the present study was to investigate the clinical factors on the incidence of prolonged ST-segment elevation following ablation of RA.

Methods

The subject comprised 140 consecutive stable angina patients with severe calcified lesions. All patients had undergone successfully elective PCI using RA and intravascular ultrasound, and had been prescribed strong statins more than 2 week before PCI regardless dyslipidemia. We investigated the occurrence of prolonged ST-segment elevation following ablation of RA with resistance to use of nitroprusside as intra-coronary vasodilators, and the clinical factors including of primary or secondary RA strategy for calcification lesions. Secondary RA strategy was defined as RA performed after pre-dilatation with small balloon (balloon/artery ratio = 0.6).

Results

Median of age was 71 years (66–80) and 98 cases (70%) were male. Of 140 target lesions, 82 (59%) were LAD (RCA; 24%, LCX; 16%, and LMT; 1%, respectively). The rates of hemodialysis and diabetes mellitus were 31% and 61%. The incidence of prolonged ST-segment elevation with resistance to use of nitroprusside as intra-coronary vasodilators was 8 cases (6%). Major complications of RA including coronary perforation, coronary rupture, burr entrapment and cardiogenic shock requiring the mechanical support were none. Univariate logistic regression analysis showed that age [Odds ratio (OR); 1.07, 95% confidence interval (CI) 0.99–1.17, p=0.103], hemodialysis (OR; 0.71, 95% CI: 0.10–3.25, p=0.688), diabetes mellitus (OR; 1.08, 95% CI: 0.25–5.46, p=0.915), use of β-blocker (OR; 0.70, 95% CI: 0.14–2.96, p=0.633), left ventricular ejection fraction (OR; 0.99, 95% CI: 0.94–1.05, p=0.781), lesion length ≥20mm (OR; 1.04, 95% CI: 0.23–7.33, p=0.962), and burr size (OR; 2.42, 95% CI: 0.53–16.95, p=0.289) were not associated with the incidence of prolonged ST-segment elevation. Multivariate logistic regression analysis for the incidence of prolonged ST-segment elevation revealed that secondary RA strategy and levels of low-density lipoprotein cholesterol (LDL-C) were independent factors of the incidence of prolonged ST-segment elevation following ablation of RA (OR; 0.05, 95% CI: 0.01–0.39, p=0.017 and LDL-C: OR 0.91, 95% CI 0.83–0.96, p=0.010, respectively).

Conclusion

Secondary RA strategy may be useful to reduce the occurrence of prolonged ST-segment elevation following ablation of RA.

Funding Acknowledgement

Type of funding sources: None.

Oxidative stress was significantly associated with peak oxygen uptake in patients with dilated cardiomyopathy

Background

Systemic oxidative stress is known to be associated with the severity and prognosis in patients with cardiovascular diseases (CVD), including chronic heart failure. On the other hand, exercise tolerance is closely related to the prognosis in heart failure patients. However, no report has examined how oxidative stress is involved in each parameter evaluated by cardiopulmonary exercise testing (CPET) in patients with dilated cardiomyopathy (DCM).

Purpose

To examine the relationship between oxidative stress and CPET parameters such as peak VO2 and VE/VCO2 slope in patients with DCM

Methods

We recruited 214 patients with CVD who were performed CPET and measured brain natriuretic peptide (BNP) and haemoglobin (Hb). Finally, we enrolled 96 patients with DCM who have dilated dimensions of the left ventricular lumen by echocardiography and are diagnosed by endomyocardial biopsy. All patients underwent CPET using 0W warm-up and 10W ramp protocol on an upright electrical bicycle ergometer. We defined low peak VO2 as peak VO2&lt;14 ml/min/kg and high VE/VCO2 slope as VE/VCO2 slope&gt;34. The oxidative stress level was evaluated by a d-ROMs test, in which the amount of organic hydroperoxide converted into radicals oxidizing N, N-diethyl-p-phenylenediamine hydroperoxide is measured. The high level of d-ROMs was defined as d-ROMs≥401 U.CARR.

Results

Mean age was 56±15 years old. Mean ejection fraction, peak VO2 and VE/VCO2 slope were 37±15%, 16.3±5.0 ml/min/kg, and 31.0±11.8, respectively. The percentage of the high level of d-ROMs was 25%. In univariable logistic regression analysis, Hb, log BNP, and the high level of oxidative stress were significantly associated with low peak VO2, whereas, in multivariable logistic regression analysis, age, Hb, and log BNP were significant factors for high VE/VCO2 slope. In multivariable logistic regression analysis, only the high level of d-ROMs was independently associated with low peak VO2 (OR 3.18, CI 1.12–9.04, p=0.030). While, in multivariable logistic regression analysis, Hb (OR 0.51, CI 0.32–0.81, p=0.004) and log BNP (OR 2.77, CI 1.33–5.76, p=0.006) were significantly related to high VE/VCO2 slope.

Conclusions

In patients with DCM, low peak VO2 was associated with the high level of d-ROMs, and high VE/VCO2 slope was associated with BNP. These results suggested that oxidative stress was only related to peak VO2.

Funding Acknowledgement

Type of funding sources: None.

Development of a risk prediction score and equation for chronic kidney disease: a retrospective cohort study

Background

Chronic kidney disease (CKD) is a risk factor for end-stage renal disease and contributes to increased risk of cardiovascular disease morbidity and mortality. We aimed to develop a risk prediction score and equation for future onset of CKD using large-scale health checkup data.

Methods

This retrospective cohort study included 58,423 participants without baseline CKD who were randomly assigned to Derivation (n=38,948) and Validation cohorts (n=19,475) at a ratio of 2:1. The predictors were anthropometric indices, life style, and blood sampling data. In the Derivation cohort, we performed multivariable logistic regression analysis and obtained the standardized beta coefficient of each factor that was significantly associated with new-onset CKD and assigned scores to each factor. We created a score and an equation to determine the risk of developing CKD after 5 years and applied them to the Validation cohort to assess their reproducibility.

Results

The risk prediction scores ranged from 0 to 16, consisting of the seven indicators, including age, sex, hypertension, dyslipidemia, diabetes, hyperuricemia, and estimated glomerular filtration rate (eGFR). From the receiver operating characteristic (ROC) curve predicting CKD incidence, the area under the curve (AUC) was 0.78. A score of ≥8 showed the highest Youden index in the Derivation cohort, with a sensitivity of 0.90 and specificity of 0.52. The CKD incidence gradually and constantly increased as the score increased from ≤6 to ≥14 (Figure). The risk prediction equation consisted of aforementioned seven indicators: 1/(1 + exp[−(9.4876 + 0.0311×age + 0.2400×sex + 0.3470×hypertension + 0.0893×dyslipidemia + 0.3444×diabetes + 0.0832×hyperuricemia + (−0.1980)×eGFR]). The median probability obtained from the Derivation cohort was 0.018 (interquartile range 0.002–0.084), and the AUC value of the ROC curve for the development of CKD after 5 years was 0.88, with a sensitivity of 0.84 and a specificity of 0.78 at a cutoff value of 0.077. The Validation cohort analysis yielded similar results.

Conclusion

We developed a clinically useful risk score and equation to predict the CKD incidence after 5 years in the general Japanese population. These models have reasonably high predictability and reproducibility.

Funding Acknowledgement

Type of funding sources: None.

The impact of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the prognosis of elderly patients with chronic limb-threatening ischemia after endovascular therapy

Background

Chronic limb-threatening ischemia (CLTI) is known to the most advanced form of severe arteriosclerosis in peripheral artery disease and cause poor prognosis. Whereas malnutrition (M), inflammation (I) and atherosclerosis (A) are reported to be involved in the pathophysiology of end-stage renal disease with close relevancy and affect its clinical outcomes, the effect of such MIA syndrome on the mortality in elderly patients with CLTI has not been well evaluated.

Purpose

The aim of the present study was to investigate the influence of patient characteristics including MIA syndrome on the mortality in elderly CLTI patients &lt;3 years after endovascular therapy (EVT).

Methods

The subject was 222 consecutive elderly (≥65 year) CLTI patients who were admitted to undergo endovascular therapy (EVT). We assessed nutritional status using Geriatric Nutritional Risk Index (GNRI) in this study, and defined patients with GNRI &lt;92 at admission as malnutrition. We also assessed inflammatory status using hs-CRP. The patients were divided into four groups based on their nutrition and inflammatory status as follows; Group A; GNRI &lt;92+hs-CRP ≥1 mg/dL, Group B; GNRI &lt;92+hs-CRP &lt;1 mg/dL, Group C; GNRI &gt;92+hs-CRP ≥1 mg/dL, Group D; GNRI &gt;92+hs-CRP &lt;1 mg/dL. Patients in the group A were considered to be under MIA syndrome. We evaluated which Group affected prognosis of elderly CLTI patients after endovascular therapy (EVT).

Results

All-cause death after EVT were 37 cases (17%). In this study, all patients underwent successful EVT for target lesions. As a result of cox proportional hazards analysis, all-cause death was associated with MIA syndrome [hazard ratio (HR): 2.41, 95% confidence interval (CI): 1.13–5.17, p&lt;0.001)], Clinical Fraility Scale (HR: 1.46, 95% CI: 1.127–1.93, p=0.005), and history of stroke (HR: 2.32, 95% CI: 1.11–4.86, p=0.026) in the univariate analysis. Multivariate cox proportional hazards analysis models after adjusted for the demographic characteristics of patients and clinically relevant factors for all-cause death after EVT revealed that MIA syndrome and history of stroke were independent risk factors (HR: 3.94, 95% CI: 1.34–11.63, p=0.013, HR: 3.06, 95% CI: 1.14–8.18, p=0.026,). Kaplan Meier analysis also elucidated that survival rate was significantly lower in Group A compared to those in other Groups (p=0.0131). Furthermore, cox proportional hazards models using each Group A to D revealed that only Group A was associated with all-cause death (Group A: HR 2.41, 95% CI: 1.13–5.17, p=0.024, Group B: HR 1.01, 95% CI: 0.41–2.46, p=0.976, Group C: HR 1.01, 95% CI: 0.35–2.88, p=0.987, Group D: HR 0.57, 95% CI: 0.30–1.13, p=0.109).

Conclusions

MIA syndrome was a strong predictor for incidence of all-cause death in elderly CLTI patients after EVT.

Funding Acknowledgement

Type of funding sources: None.

Priority of non-HDL-C assessment to predict occurrence of new lesions after percutaneous coronary intervention in stable angina patients with diabetes mellitus prescribed strong statins

Background

Diabetes mellitus (DM) patients are known to suffer from a higher risk of adverse outcomes following percutaneous coronary intervention (PCI) despite of low-density lipoprotein cholesterol (LDL-C)-lowering therapy with statins. Thus, identification of factors that may occurrence of new lesions following PCI in DM patients treated with strong statin is clinically important. Although LDL-C is generally calculated using the Friedewald equation method [LDL-C (F)], the effects of LDL-C measured by the Martin method [LDL-C (M)] or non-high-density lipoprotein cholesterol (non-HDL-C) on the occurrence of new lesions on coronary angiography after PCI among stable angina patients with DM receiving treatment with strong statins are unknown.

Purpose

The aim of the present study was to investigate the clinical factor on the occurrence of new lesions in stable angina patients with DM at 9-month follow-up coronary angiography and within 2 years after PCI.

Methods

The subject was 313 consecutive stable angina patients with DM who were admitted to undergo PCI. All patients had undergone successfully elective PCI using second-generation drug-eluting stents and intravascular ultrasound, and had been prescribed strong statins regardless dyslipidemia more than 2 week before PCI. We investigated the clinical factor on the occurrence of new lesions with myocardial ischemia. We estimated LDL-C (F), LDL-C (M), and non-HDL-C in this study. Acute coronary syndrome and hemodialysis patients were excluded from this study.

Results

Median of age and level of glycosylated hemoglobin (HbA1c) were 69 years (62–76) and 6.8% (6.3–7.3). New lesions appeared 9-month follow-up coronary angiography [New lesion(+) 9-month] and within 2 years [New lesion(+) 2-year] after PCI in 19 (6%) and 62 (20%) patients, respectively. The rate of history of smoking, using of β-blocker, and non-HDL-C ≥100 mg/dL and level of HbA1c were significantly higher in the New lesion(+) 9-month group than those in the New lesion(−) 9-month group after PCI. Age, level of high-sensitivity C-reactive protein and triglyceride, frequencies of LDL-C (F) ≥70 mg/dL, LDL-C (M) ≥70 mg/dL and non-HDL-C ≥100 mg/dL were significantly higher in the New lesion(+) 2-year group than those in the New lesion(−) 2-year group after PCI. Multivariate logistic regression analysis demonstrated only non-HDL-C ≥100 mg/dL was associated with the occurrence of new lesions both 9-month and within 2 years [9-month: hazard ratio (HR) 4.25, 95% confidence interval (CI) 1.30–19.23, p=0.014 and 2-year: HR 2.30, 95% CI 1.24–4.45, p=0.010].

Conclusion

Only non-HDL-C ≥100 mg/dL was an independently associated with the occurrence of new lesions both 9-month and within 2 years after PCI in stable angina patients with DM treated with strong statins. Residual risk after PCI in DM patients should be considered by assessing non-HDL-C beyond the scope of LDL-C-lowering therapy with strong statins.

Funding Acknowledgement

Type of funding sources: None.

Khorana score at an initial chemotherapy is effective on predicting death in patients with gastrointestinal cancer

Background

The Khorana risk score (KRS) has been recommended for predicting an incidence of cancer-associated thrombosis (CAT). On the other hand, KRS is that the specific gravity of score for the primary tumor is too high and the prevalence of severe obesity is low, so there are some reports that the KRS is not effective in predicting CAT but is effective in predicting death.

Purpose

The purpose of this retrospective cohort study was to evaluate the efficacy of KRS on predicting CAT and all-cause death at an initial chemotherapy in patients with gastrointestinal cancer.

Methods

260 consecutive patients with no history of thrombosis who started an initial chemotherapy for gastrointestinal cancer during a 2-year period from January 2017 to December 2018 in our hospital were divided into 3 groups according to KRS and observed until December 2019 (122 patients (46.9%) in the low-risk group (0 points), 114 patients (43.8%) in the intermediate-risk group (1–2 points), and 24 patients (9.2%) in the high-risk group (3–6 points)). The incidence of CAT and all-cause death was compared among 3 groups.

Results

The median age of the patients was 67 (60–75) years, and 63.5% of them were male. CAT was observed in 61 patients (23.5%), and 84 patients (32.3%) died during the observation period. There was no difference in the incidence rate of CAT among 3 groups (Log-rank P=0.6), but all-cause death was a significant difference among 3 groups (high risk group: 54.2%, intermediate risk group: 36.0%, low risk group: 24.6%, p value=0.0023). After adjustment for multivariate analysis, the KRS high risk group was still significantly associated with death (HR: 2.83, 95% CI: 1.37–5.83, p value =0.0049), but not with CAT.

Conclusion

The Khorana score at an initial of chemotherapy in patients with gastrointestinal cancer is useful in predicting prognosis, but not CAT.

Funding Acknowledgement

Type of funding sources: None.

Derivation and validation of a pretest probability score for deep vein thrombosis before surgery

Background

Venous thromboembolism represents a crucial perioperative complication and causes morbidity and mortality. It is important to predict deep vein thrombosis (DVT) before surgery under general anesthesia.

Purpose

We developed a pretest probability score for predicting DVT with perioperative clinical and laboratory variables.

Methods

Total 7435 patients were planed surgery under general anesthesia between 2017 and 2018. 1313 patients were performed whole leg ultrasonography suspected DVT using cutoff point of D-dimer ≥1μg/ml. We excluded age &lt;18 years, ongoing anticoagulant therapy, other thrombosis, protein C deficiency, disseminated intravascular coagulation, central venous catheter, pregnancy and aneurysm. We enrolled 971 patients, we divided into the derivation cohort or the validation cohort. The association of DVT with multiple variables was characterized in a derivation cohort of 651 patients. The score validated in an independent cohort of 322 patients from the same study. We also performed a validation of this model in an independent cohort of patients derived from the same observational study.

Results

We found 6 clinical and 1 laboratory parameters that predicted DVT in patients before surgery. The prediction rule for DVT assigned 2 points for D-dimer more than 1.44 μg/ml and 1 point for age ≥60 years, female, ongoing steroid, active cancer with high risk of DVT, prolong immobility and antipsychotic drug. In derivation and validation cohorts, area under the curve was 0.73 and 0.70, respectively. New preoperative risk model with these parameters stratified patients into 3 individual categories corresponding to the risk of DVT. Rates of DVT in the derivation and validation cohorts, respectively, were 6% and 7% in low-risk (score 0–2), 22% and 21% in intermediate-risk (score 3–4), and 49% and 47% in high-risk (score ≥5) category. Rates of fresh DVT were 1% and 3% in low-risk, 10% and 9% in intermediate-risk, and 33% and 19% in high-risk category.

Conclusion

This score stratifies perioperative DVT risk and may detect effectively DVT. The findings should be considered with the further prospective research.

Funding Acknowledgement

Type of funding sources: None. Rate of DVT

Gender differences in the effects of weight reduction on future blood pressure elevation in the overweight middle-aged population

Background

The effectiveness of weight loss (WL) to prevent blood pressure (BP) elevation is common knowledge; however, the effect of gender differences on this efficacy is not known. We aimed to investigate whether there were gender differences in the degree of BP increase and the prevalence of hypertension in the future when middle-aged obese participants achieved slight WL.

Methods

We analyzed the annual health checkup data for the general Japanese population collected from January 2001 through December 2015. Middle-aged participants (40–49 years old) with overweight (body mass index [BMI], 25.0–29.9 kg/m2) who had examination data for two follow-up time-points (after 3 and 10 years) were included. The participants with a BMI decrease ≥1.0 kg/m2 in 3 years (WL group) were propensity score (PS)-matched to those with a BMI decrease &lt;1.0 kg/m2 or weight gain (non-WL group) based on the data of the first examination, including age, BMI, smoking and drinking status, eGFR, systolic BP and diastolic BP, and hypertension (defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg). We compared the BMI, systolic BP, and hypertension prevalence after 10 years in both groups.

Results

There were 17,554 individuals, aged 40–49 years, with overweight. After excluding subjects who did not satisfy the inclusion criteria and PS matching, we identified 232 men and 160 women in both WL and non-WL groups. The BMI in the WL group after 3 years was significantly lower than that in the non-WL group (men, 25.2±1.4 kg/m2 vs. 27.1±1.6 kg/m2, P&lt;0.001; women, 24.9±1.4 kg/m2 vs. 27.1±1.5 kg/m2, P&lt;0.001), and the significance persisted even after 10 years among both men and women (men, 25.5±1.8 kg/m2 vs. 26.8±2.1 kg/m2, P&lt;0.001; women, 25.3±2.0 kg/m2 vs. 26.8±2.2 kg/m2, P&lt;0.001). Among women, the systolic BP and hypertension prevalence after 10 years were significantly lower in the WL group than in the non-WL group (systolic BP, 124.8±16.3 mmHg vs. 130.3±19.0 mmHg, P&lt;0.01; hypertension prevalence, 35.0% vs. 48.1%, P&lt;0.05). In contrast, there were no significant differences in the SBP and hypertension prevalence after 10 years among men between the groups (systolic BP, 129.0±17.7 mmHg vs. 129.0±17.5 mmHg, P=0.96; hypertension prevalence, 46.1% vs. 48.7%, P=0.57).

Conclusions

There were gender differences in the effectiveness of WL to prevent future BP elevation in overweight middle-aged participants. WL could prevent future BP elevation and the hypertension onset in women but not in men.

Funding Acknowledgement

Type of funding source: None

History of stroke is a major factor to affect prognosis of elderly chronic limb-threatening ischemia patients with frailty after endovascular therapy

Background

Chronic limb-threatening ischemia (CLTI) is the most advanced form of severe arteriosclerosis, and CLTI patients are known to have poor prognosis due to complication of polyvascular diseases, including cerebrovascular disease. Stroke often causes disability of exercise, leading to develop frailty and sarcopenia, and frailty and sarcopenia are known to important factors affecting the prognosis of cardiovascular disease. However, the effect of history of stroke for clinical outcomes in elderly CLTI patients with frailty has not been well evaluated.

Purpose

The aim of the present study was to investigate whether a history of stroke affects prognosis of elderly CLTI patients with frailty after endovascular therapy (EVT).

Methods

The subject was 228 consecutive elderly (≥65 year) CLTI patients underwent EVT. These patients had frailty with clinical frailty scale 5 or 6 or 7 which was defined by Geriatric Medicine Research. Clinical frailty was assessed on admission before procedure of EVT by physicians or other health professionals. The study patients were divided into two groups based on patients with or without history of stroke group (Group A and B). We investigated the association between history of stroke on admission and outcome after EVT.

Results

All-cause death ≤6 month and ≤12 month after EVT were 10 cases (4%) and 19 cases (8%). Group A had higher rate of all-cause death ≤6month and ≤12 month (14 vs. 3%, p=0.012, 19 vs. 6%, p=0.019) than those of Group B. Kaplan Meier analysis elucidated that survival rate was significantly lower in Group A compared to that in Group B (p=0.031). As a result of cox proportional hazards analysis, all-cause death ≤6 month was associated with history of stroke [hazard ratio (HR): 5.07, 95% confidence interval (CI): 1.47–17.52, p=0.010)], hs-CRP (HR: 1.09, 95% CI: 1.01–1.16, p=0.010) in the univariate analysis. Similarly, cox proportional hazards analysis for revealed that history of stroke (HR: 3.02, 95% CI: 1.19–7.68, p=0.020), hs-CRP (HR: 1.09, 95% CI: 1.03–1.14, p&lt;0.001), hemodialysis (HR: 2.53, 95% CI: 1.03–6.24, p=0.043), use of clopidogrel (HR: 0.22, 95% CI: 0.07–0.78, p=0.019) and serum albumin level (HR: 0.40, 95% CI: 0.21–0.80, p=0.008) were significantly associated with all-cause death ≤12 month. Multivariate analysis models after adjusted for the demographic characteristics of patients and clinically relevant factors for all-cause death ≤6 month and ≤12 month after EVT revealed that history of stroke was an independent risk factor (HR: 5.18, 95% CI: 1.44–17.43, p=0.011, HR: 2.98, 95% CI: 1.71–7.61, p=0.022).

Conclusions

These data suggested that history of stroke was a crucial independent predictor for incidence of all-cause death in elderly CLTI patients with frailty.

Funding Acknowledgement

Type of funding source: None

Fib4 index is a more relevant marker for pulse wave velocity but not for carotid intima-media thickness in a men population

Background

Carotid intima-media thickness (IMT) and pulse wave velocity (PWV) are useful markers for predicting cardiovascular disease not only in patients with cardiovascular disease but also in the general population. On the other hand, liver disease due to obesity has become a problem and has been reported to be associated with the progression of atherosclerosis. Recently, an indicator of liver stiffness, the Fibrosis-4 index (Fib4 index), has been used to detect the pre-stage liver diseases. However, there is no report to investigate the association between atherosclerotic parameters such as IMT and PWV, and Fib4 index. The Fib4 index is a simple index calculated from age and three blood sample data, and it will be useful for screening for an early stage of atherosclerosis if we can show the association between Fib4 index and these parameters.

Purpose

To investigate the association between atherosclerotic parameters such as IMT or PWV and Fib4 index

Methods

We recruited 3, 128 men participants who underwent health checkup. IMT was evaluated by carotid ultrasonography, and branchial-ankle PWV (baPWV) was measured by an automatic device. We analysed the association of IMT or baPWV with Fib4 index and atherosclerotic risk factors such as age, systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C) and fasting blood sugar (FBS). baPWV ≥1,600 cm/s was defined high baPWV and we performed the receiver operating characteristics (ROC) analysis to demonstrate the significance of Fib4 index for baPWV.

Results

Mean Fib4 index was 1.39±0.68. In the univariate linear regression analysis, all factors such as age, SBP, LDL-C, FBS, Fib4 index were significantly associated with IMT or baPWV. On the other hand, in the multivariate linear regression analysis, Fib4 index was an independent factor for baPWV but not for IMT (IMT, p=0.498; baPWV, p=0.023). Figure 1 showed the result of ROC analysis to predict the high baPWV by Fib4 index. The area under curve (AUC) was 0.73, with the highest discriminating sensitivity and specificity at 0.71 and 0.65, respectively at Fib4 index = 1.27.

Conclusions

Fib4 index was significantly related to baPWV and could be the useful screening marker for arterial stiffness in a general men population.

Figure 1. ROC curve analysis

Funding Acknowledgement

Type of funding source: None

Malnutrition is a major factor to affect prognosis of patients undergo percutaneous coronary intervention for coronary artery disease with calcified lesions

Background

In patients undergo PCI for coronary artery disease, target lesion calcification is associated with major cardiac events. Malnutrition is the important factor to cause frailty and sarcopenia which affect prognosis of cardiovascular diseases. However, the relationship between morphology in target lesions and malnutrition in patients undergo PCI is still uncertain.

Purpose

The aim of the present study was to investigate how malnutrition affects prognosis of stable angina patients underwent PCI and morphology in target lesions.

Methods

The subject was 206 consecutive stable angina patients undergone successful PCI using second-generation drug eluting stents and intravascular ultrasound (IVUS). The study patients were divided into two groups based on malnutrition or non-malnutrition. Nutritional status was assessed by Geriatric Nutritional Risk Index (GNRI), and patients with GNRI&lt;92 at admission were defined as malnutrition group (MG). We investigated the association between malnutrition on admission and outcome, and morphology in target lesions assessed by IVUS. Target lesion morphology were divided into moderate/severe calcified group and none/mild calcified group.

Results

All-cause death and MACCE (major cardiovascular and cerebrovascular events) ≤3 years after PCI were 15 cases (7%) and 33 cases (16%). MG had higher rate of all-cause death (20 vs. 6%, p=0.001) and MACCE (37 vs. 10%, p&lt;0.001) than those of non-MG. Kaplan Meier analysis elucidated that survival rate was significantly lower in MG compared to that in non-MG (p&lt;0.001). As a result of cox proportional hazards analysis, all-cause death was associated with age [hazard ratio (HR): 1.05, 95% confidence interval (CI): 1.01–1.10, p=0.006)], hs-CRP (HR: 1.03, 95% CI: 1.03–1.12, p&lt;0.001), hemodialysis (HR: 2.25, 95% CI: 1.08–4.68, p=0.029), left ventricular ejection fraction (LVEF) (HR: 0.97, 95% CI: 0.95–0.99, p=0.017) and malnutrition (HR: 4.38, 95% CI: 2.11–9.09, p&lt;0.001) in the univariate analysis. Similarly, cox proportional hazards analysis revealed that age (HR: 1.04, 95% CI: 1.01–1.07, p=0.018), hs-CRP (HR: 1.08, 95% CI: 1.03–1.11, p&lt;0.001), hemodialysis (HR: 2.68, 95% CI: 1.45–4.94, p=0.002), LVEF (HR: 0.97, 95% CI: 0.95–0.99, p=0.002) and malnutrition (HR: 4.14, 95% CI: 2.23–7.67, p&lt;0.001) were significantly associated with MACCE. Multivariate analysis for all-cause death and MACCE revealed that malnutrition was an independent risk factor (HR: 3.47, 95% CI: 1.52–7.94, p=0.003, HR: 3.76, 95% CI: 1.87–7.58, p&lt;0.001). Furthermore, MG was significantly associated with moderate/severe target calcified lesions assessed by IVUS compared to those of patients in non-MG (67 vs. 27%, p&lt;0.001) regardless with or without hemodialysis.

Conclusions

Malnutrition was a crucial independent risk factor for stable angina patients who underwent PCI and was significantly associated with moderate/severe target calcified lesions.

Funding Acknowledgement

Type of funding source: None

Gender-specific relationship between abdominal obesity and prevalence of new-onset atrial fibrillation in the general Japanese population

Background

The number of incidences of atrial fibrillation (AF) is expected to rise rapidly in the near future because of the increased number of geriatric patients in Japanese society. In addition, obesity is increasing in the general Japanese population. Although a higher body mass index is associated with a higher risk of AF, the relationship between abdominal obesity (large waist circumference) and new-onset AF is unclear.

Methods and results

We performed a longitudinal retrospective observational study from January 2007 to October 2018 using the annual health checkup data. Data from 58,844 adults (29,572 males, age 54±13 years) without baseline AF, who underwent routine health checkups, were analyzed. We performed logistic regression analyses to determine the strength of the association between abdominal obesity and new-onset AF. We also examined the effect of abdominal obesity on the incidences of AF stratified by gender. During a median follow-up of 4 years, we recorded new cases of AF in 322 (0.5%) individuals. In univariate analysis, a large waist circumference was significantly associated with new-onset AF, both in males [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02 to 1.05, p&lt;0.001] and in females (HR 1.04, 95% CI 1.01 to 1.06, p=0.002), respectively. In multivariate analysis adjusted for clinical variables (age, hypertension, dyslipidemia, estimated glomerular filtration rate, habitual drinking and diabetes), a large waist circumference was significantly and independently associated with new-onset AF in males (HR 1.04, 95% CI 1.03 to 1.06, p&lt;0.001), but not in females (HR 1.01, 95% CI 0.99 to 1.04, p=0.269).

Conclusion

Abdominal obesity is independently associated with an increased risk of new-onset AF in males. This association in males might imply some sex-specific mechanisms. There might be a gender difference in the effectiveness of interventions to decrease abdominal obesity to prevent AF.

Funding Acknowledgement

Type of funding source: None

Practice patterns, feasibility and efficacy of coronary artery angiography using distal radial approach

Background

Most patients undergo coronary angiography by transradial approach. However, recently distal radial approach has been introduced as a novel approach for coronary angiography and intervention. There is uncertainty on the feasibility and safety of distal radial approach for coronary angiography.

Methods

All consecutive 1450 coronary angiography cases (distal radial approach 237 cases, conventional transradial approach 1213 cases) between October 2018 and December 2019 were included in this study. Emergency coronary angiography cases and ad hoc coronary intervention cases were excluded. Patients were stratified into distal radial approach and conventional radial approach subgroups. Baseline characteristics, contrast amount, procedure time, radiation amount, fluoroscopy time, and complications in catheterization laboratory were statistically analyzed.

Results

There were no significant differences in age and gender between distal radial vs transradial groups: mean age, 70.8±10.5 vs 70.8±11.0 years; % of males, 77.2% vs 66.9%. Procedure time was significantly shorter in distal radial approach group (28.7±13.3 min vs 32.3±14.2 min, p&lt;0.05) and total radiation amount during procedure was significantly less in distal radial approach group (366.4±189.5 ml vs 412.9±220.3 mGy, p&lt;0.05).

Conclusions

Coronary angiography with distal radial approach decreases the procedure time and total radiation amount. It is feasible and safe in most stable patients.

Funding Acknowledgement

Type of funding source: None

P6232Exploring the bottom of J-shaped curve association between serum uric acid and cardiovascular risks: description using a large Japanese general population

Background

The J-shaped association between serum uric acid (SUA) and cardiovascular risks is known. However, the bottom of the J-shaped curve has not been elucidated because of the lack of epidemiological knowledge about hypouricemia.

Purpose

To explore the SUA levels related to the most preferable cardiovascular risks using data from a Japanese general population.

Methods

Data from 246,923 individuals (111,117 men and 135,806 women) who underwent routine health checkups between January 2001 and December 2015 were analyzed. The participants were divided into quartiles according to their SUA levels, and patients with hypouricemia (SUA level <2.0 mg/dL) were subdivided into two groups according to their distributions. We compared their characteristics, including their cardiovascular risks.

Results

The prevalence of hypouricemia was 0.46% overall, 0.21% for men, and 0.66% for women (P<0.001). The subjects with hypouricemia were divided into two groups according to SUA level: a lower hypouricemia group (0.4–1.1 mg/dL, which included a peak at 0.7–0.8 mg/dL) and a higher hypouricemia group (1.4–2.0 mg/dL). The two groups exhibited significanly different characteristics in several variables: body mass index and triglyceride in men, and age, body mass index, triglyceride, low-density lipoprotein cholesterol, and renal function in women. Furthermore, several cardiovascular risk factors showed the most preferable values in subjects with SUA 1.4–2.0 mg/dL (Figure).

Conclusions

There were two independent distributions in subjects with SUA ≤2.0 mg/dL. The individuals with SUA 1.4–2.0 mg/dL exhibited the most preferable values for several cardiovascular risk factors, suggesting an association with the bottom of the J-shaped curve between SUA and cardiovascular risks.

P3626Malnutrition is a major factor to affect prognosis of coronary artery disease patients with myocardial damage

Background

Malnutrition is the important factor to cause frailty and sarcopenia which affect the prognosis of cardiovascular diseases. However, the effect of malnutrition on prognosis of coronary artery disease (CAD) patients with myocardial damage is still uncertain.

Purpose

The aim of the present study was to investigate the effect of malnutrition on prognosis of CAD patients with myocardial damage who received percutaneous coronary intervention (PCI).

Methods

The subjects were 241 CAD patients with myocardial damage due to myocardial ischemia by coronary artery stenosis or occlusion. These patients underwent successful revascularization for CAD by PCI using second-generation drug eluting stents and discharged. Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional status in this study, and patients with GNRI<92 at baseline were defined as malnutrition group. The association between MACCE (major cardiovascular and cerebrovascular events) after discharged and patient's characteristics including nutritional status at baseline were assessed.

Results

The mean follow-up period was 546±310 days, with a maximum follow-up duration of 1092 days. MACCE within 3 years after PCI were 42 cases (17%) and malnutrition group had high rate of MACCE (38 vs. 11%, P<0.01) compared with non- malnutrition group. In malnutrition group, age (77±9 vs. 67±11 years, P<0.01) and high-sensitivity C-reactive protein (hs-CRP) level (5.52±6.63 vs. 0.72±1.86 mg/dl, P<0.01) were higher than those of non-malnutrition group. The serum albumin (Alb) level (3.0±0.5 vs. 4.0±0.4 mg/dL, P<0.01), hemoglobin (Hb) (10.4±1.9 vs. 12.8±2.4 g/dL, P<0.01), total cholesterol (151.8±32 vs. 174.1±41.6 mg/dL, P<0.01), triglycerides (96.9±49.1 vs. 140.6±128.3 mg/dL, P<0.01), and left ventricular ejection fraction (LVEF) (50.2±15.9 vs. 55.9±15.3%, P=0.03) were lower in malnutrition group than those in non-malnutrition group. Moreover, malnutrition group had lower rate of hemodialysis (HD) (35 vs. 65%, P<0.01), dyslipidemia (16 vs. 84%, P<0.01) and using of statins (16 vs. 83%, P=0.02) than those in non-malnutrition group. As a result of Cox proportional hazards analysis, MACCE was associated with age [hazard ratio (HR): 1.04, 95% confidence interval (CI): 1.01–1.07, p p<0.01)], hs-CRP (HR: 1.08, 95% CI: 1.03–1.11, p<0.01), HD (HR: 2.63, 95% CI: 1.51–4.58, p<0.01) and malnutrition (HR: 3.69, 95% CI: 2.11–6.42, p<0.01) in the univariate analysis. The multivariate Cox proportional hazards analysis revealed that HD (HR: 2.24, 95% CI: 1.24–4.08, p<0.01) and malnutrition (HR: 2.10, 95% CI: 1.04–4.23, p=0.03) were significantly associated with MACCE. Furthermore, malnutrition additively facilitated incidence of MACCE among patients underwent HD (GNRI <92+HD: HR 4.19, 95% CI: 2.22–7.88, p<0.001, GNRI >92+HD: HR 1.26, 95% CI: 0.65–2.47, p=0.493).

Conclusions

In CAD patients with myocardial damage, malnutrition (GNRI<92) is a major risk factor for MACCE after PCI.

Effect of porcine placental extract on the mild menopausal symptoms of climacteric women

OBJECTIVES

This study assessed the effects of oral porcine placental extract (PPE) on the mild menopausal symptoms of climacteric women.

METHODS

In this 12-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study, 50 climacteric Japanese women were randomized 1 : 1 to oral PPE (300 mg/day) or placebo. Menopausal symptoms were evaluated by using the Simplified Menopausal Index (SMI), as were serum estradiol (E2) and follicle stimulating hormone (FSH) levels. Blood biochemical and cellular and urinary tests were done to evaluate safety aspects of repeated oral administration of PPE.

RESULTS

The total SMI score of the PPE group was significantly more improved after 12 weeks than that of the placebo group (p = 0.031). This score and three subscores (vasomotor, psychological, and somatic symptoms) were significantly improved at 8 and/or 12 weeks compared with the initial values in the PPE group (p < 0.05). E2 and FSH levels were not improved in either group. No adverse events were observed.

CONCLUSIONS

Oral PPE at 300 mg/day improved the mild menopausal symptoms of climacteric women. Since oral PPE did not improve serum E2 and FSH levels, PPE is thought not to ameliorate hormonal balance itself but to improve subjective feelings of climacteric women.

Characterization of Dental Epithelial Progenitor Cells Derived from Cervical-loop Epithelium in a Rat Lower Incisor

Dental epithelial progenitor cells differentiate into various cell types during development of tooth germs. To study this mechanism, we produced immortalized dental epithelial progenitor cells derived from the cervical-loop epithelium of a rat lower incisor. The expression patterns of cytokeratin 14, nerve growth factor receptor p75, amelogenin, Notch2, and alkaline phosphatase were examined by immnohistochemistry in both lower and higher cell densities. The patterns of each were compared in the dental epithelium of rat lower incisors. The results demonstrated that these cells could produce ameloblast lineage cells, stratum intermedium cells, stellate reticulum, and outer enamel epithelium. Furthermore, fibroblast growth factor 10 stimulated proliferation of dental progenitor cells and subsequently increased the number of cells expressing alkaline phosphatase. These results suggest that fibroblast growth factor 10 plays a role in coupling mitogenesis of the cervical-loop cells and the production of stratum intermedium cells in rat incisors.

Stimulation of liver regeneration after hepatectomy in mice by injection of bone marrow mesenchymal stem cells via the portal vein

AIM

To investigate whether mouse bone marrow mesenchymal stem cells (BMC) stimulate liver regeneration after partial hepatectomy.

METHODS

Isolated BMCs were purified by density gradient centrifugation. We performed a 70% hepatectomy in male BALB/c mice followed by injection of BMCs into the portal vein (PV-BMC group), or the tail vein (IV-BMC group), or of saline into the portal vein (control group).

RESULTS

The wet weight of the liver remnant increased significantly in the PV-BMC group at 3 and 5 days after hepatectomy compared with the IV-BMC and control groups. The Ki-67 labeling index revealed that the increase to result from stimulation of DNA synthesis. The constitutive interleukin-6 and hepatocyte growth factor mRNAs in the remnant liver tended to increase in the PV-BMC group at 3 days after hepatectomy.

CONCLUSIONS

These results demonstrated that BMC injection into the portal vein enhanced liver growth after partial hepatectomy in mice.

PTH and stem cells

At least 2 different types of cells, hematopoietic and mesenchymal, are present in the adult bone marrow, in addition to endothelial cells. Hematopoietic and mesenchymal cells are believed to originate from hematopoietic stem cells (HSC) and mesenchymal stem cells (MSC), respectively. The bone marrow stroma, a cellular microenvironment that supports HSC, is composed of non-hematopoietic cells and contains MSC. A unique expansion of the bone marrow stroma, also known as marrow fibrosis, is the hallmark of a variety of disorders including hyperparathyroidism and fibrous dysplasia. PTH is the first bone anabolic agent approved by US Food and Drug Administration for the treatment of osteoporosis. Recent studies have suggested that PTH treatment may affect the number of hematopoietic stem cells in the bone marrow and their mobilization into the bloodstream. In addition, cells with classical features of mesenchymal stem cells/progenitors have been shown to express receptors for PTH, and to increase in number and undergo redistribution in the adult bone marrow upon PTH treatment. In this review, we will summarize the up-to-date knowledge on PTH and its relation to stem cells. We will also discuss the contribution of different cell types to the development of marrow fibrosis and the involvement of PTH signaling in this pathology.

Patency assessment of the internal jugular vein after neck dissection

Twenty-seven patients with oral malignant tumours, who underwent neck dissection with preservation of the internal jugular vein (IJV), were studied retrospectively to evaluate patency of the IJV. Twenty-three patients underwent ablative surgery of the primary lesion with neck dissection and 4 underwent neck dissection alone. Three patients received simple closure and skin grafting of the primary lesion, and 20 received reconstruction surgery (4 platysma flaps, 3 radial forearm flaps, 3 lateral upper arm flaps, 2 pectoralis major myocutaneous flaps and 8 rectus abdominis myocutaneous flaps). The maximum and minimum diameters of the IJV as measured on computed tomographic (CT) scans were used to assess patency. The cross-sectional area of the IJV and the ratio of its long axis to short axis (L/S ratio) were calculated. The relation between the change in IJV status and the type of flap used for reconstruction was also examined. Occlusion of the IJV was present in 3.7% of the patients, and 'narrowing' was present in 63.6%. The size of the flap significantly correlated with 'narrowing' of the IJV, suggesting that 'narrowing' was caused mainly by compression due to the flap.

Characteristics of an ammonia-oxidizing bacterium with a plasmid isolated from alkaline soils and its phylogenetic relationship

An ammonia-oxidizing bacterium, strain TCH716, was isolated from alkaline soil at Harbin city, China. The cells of strain TCH716 are lobate (0.8-1.5 x 1.0-2.0 microm), gram-negative, obligately aerobic, and nonmotile. Colonies (1-2 mm in diameter) on gellan gum plate culture are reddish, circular, and smooth. The G + C content of DNA is 54.78 mol%. Its percentage of 16S rRNA gene sequence similarity (%) to Nitrosolobus multiformis ATCC 25196T (type strain) is 98.56%. This bacterium has an optimal growth temperature and pH at 30 degrees C and 8.0-8.5, respectively. The concentration of ammonium sulfate in the HEPES medium for optimum growth of this bacterium is 38 mM. Strain TCH716 was found to have a plasmid (approximately 6.5 kbp) that possessed a plasmid-linked gene for sulfonamide resistance. Phosphoglycerate kinase, RubisCO and PEPC were found to possess high specific activities compared to the activities of these enzymes in strain ATCC 25978T. In identification of strain TCH716, both morphological characteristics (compartmentalized cells) and the phylogenetic relationship based on 16S rRNA gene sequence are important. Based on results obtained, strain TCH716 belongs to the genus Nitrosolobus, and designated as Nitrosolobus sp. TCH716.

Healing of fractures in osteoporotic rat mandible shown by the expression of bone morphogenetic protein-2 and tumour necrosis factor-α

We studied the healing process of mandibular closed fractures in osteoporotic rats using specific antibodies to bone morphogenetic protein-2 (BMP-2) and tumour necrosis factor-alpha (TNF-alpha). We confirmed the osteoporosis in rats after oophorectomy by micro-CT, and then caused unilateral closed fractures in the mandible and monitored the healing process after 7, 14, 21, and 28 days. Data were compared simultaneously with those from a group of rats that had a sham operation. During healing of the fracture in the osteoporotic group there was a prolonged phase of endochondral ossification, with an increased number of osteoclasts (p<0.01). Expressions of BMP-2 and TNFalpha were more pronounced in the osteoporotic group and there was an increase in the number of osteoblasts and TNFalpha(+) cells compared with the normal control (p<0.01). BMP-2 was related to the differentiation of osteoblasts and the higher values of TNFalpha were correlated with the up-regulation of osteoclasts during the prolonged phase of bone turnover. We conclude that the healing of fractures in osteoporotic bone is delayed about a week compared with controls. In the healing of fractures in osteoporotic bone, there were more osteoblasts and osteoclasts but there was a predominance of osteoclasts probably induced by TNFalpha. The prolonged phase of bone turnover with osteoclast predominance in the osteoporotic group is suggestive of the cause of delay in the healing of the fracture.

Application of fuzzy inference to European patients to predict cervical lymph node metastasis in carcinoma of the tongue

In head and neck cancers, the presence of cervical lymph node metastasis is an important determinant of outcome. Many attempts have been made to predict cervical lymph node metastasis, but the accuracy of currently available techniques remains inadequate. We used fuzzy inference to predict cervical lymph node metastasis retrospectively in 75 patients with squamous cell carcinoma of the tongue and prospectively in 23 patients. Our model was based on three variables: tumor size, keratinization, and mode of invasion. The accuracy of fuzzy inference for the prediction of cervical lymph node metastasis in the 75 patients studied retrospectively was 86.7%, the sensitivity was 70.8%, and the specificity was 94.1%. In the 23 patients studied prospectively, the accuracy was 91.3%, the sensitivity was 50.0%, and the specificity was 95.2%. The accuracy obtained in this European series of patients was similar to that previously obtained in Japanese patients. We conclude that fuzzy inference may be a useful method for predicting cervical lymph node metastasis. Its high specificity is likely to reduce the number of unnecessary neck dissections. However, the current level sensitivity is inadequate for routine clinical use. Therefore, other predictors of lymph node metastasis should be identified to refine the current model.

Effect of nifedipine on endothelial function in normotensive smokers: potential contribution of increase in circulating hepatocyte growth factor

Calcium antagonists are reported to have protective effects on the endothelium in vitro and in vivo. Especially, nifedipine, among many calcium antagonists, was shown to improve endothelial dysfunction in patients with hypertension. However, no report has determined whether the improvement of endothelial dysfunction by nifedipine is due to direct effects or indirect effects such as its hypotensive effect. Thus, in this study, we evaluated the direct effects of nifedipine on smoking-induced endothelial dysfunction, since cigarette smoking itself is a major factor in damage of endothelial cells, as well as hypertension. We examined whether nifedipine improves endothelial function in 10 normotensive smokers without any risk factors for atherosclerosis. The subjects were treated with 20 mg nifedipine monotherapy (n = 10) or placebo (n = 10) for 4 weeks. Nifedipine did not affect blood pressure and heart rate of normotensive smokers. We measured forearm blood flow (FBF) by strain-gauge plethysmography after 2 and 4 weeks of treatment. Changes in vasodilator response to reactive hyperaemia were significantly improved in nifedipine-treated subjects (P < 0.05), while there was no significant change in FBP response in control subjects. Response to nitroglycerin was not changed in either group. Moreover, to evaluate the mechanisms of the direct effects of nifedipine on the endothelium, we focused on hepatocyte growth factor (HGF), which is a novel angiogenic growth factor with an antiapoptotic action on endothelial cells. Interestingly, serum HGF concentration in smokers treated with nifedipine was significantly elevated both at 2 and 4 weeks (P < 0.05). Overall, these results demonstrated direct effects of nifedipine in the improvement of endothelial dysfunction in normotensive smokers. The increase in serum HGF concentration by nifedipine might contribute to the improvement of endothelial dysfunction.

Comparison of the healing process in plated and non-plated fractures of the mandible in rats

We compared the healing process of plated and non-plated fractures. The mandibles of 72 male Wistar rats were fractured and more either plated or not plated (n = 36 in each group). The healing process of the two conditions was studied histologically and immunohistochemically using a specific antibody to bone morphogenetic protein-2 (BMP-2). The results showed that the healing process in the plated group was delayed by one week compared with the non-plated group. Trauma to the surrounding soft tissues affected the healing process. BMP-2 was expressed at all stages in both groups. We conclude that the healing process is disturbed by the fixing of a plate; that periosteum is one of the main sources of osteogenic cells; and that BMP-2 is an important regulator of morphogenesis.

Midkine induced growth of ameloblastoma through MAPK and Akt pathways

Midkine (MK) is expressed during tooth development and, since ameloblastoma is thought to be arisen from the epithelium of the odontogenic apparatus or its remnant tissues, the effect of MK in ameloblastoma cell growth should be examined. The expression and function of MK were examined using 37 ameloblastoma tissues and AM-1 cells, an HPV-16DNA transfected ameloblastoma cell line. We found that MK was immunohistochemically expressed in 70% of ameloblastoma cases and AM-1 cells. By stimulation with 100 ng/ml MK, the growth of AM-1 cells was accelerated two fold by the 9th day. MK could induce phosphorylation of p44/42 MAPK (Thr202/Tyr204) and Akt (Ser473 and Thr308), and by pretreatment of PD98059, MEK1 inhibitor, or LY294002, PI3K inhibitor, MK-stimulated-phosphorylation of MAPK and Akt and MK-stimulated growth of AM-1 cells were inhibited. These results suggested that MK induced growth of ameloblastoma is through the MAPK and Akt pathways.

Endoscopic removal of a dental implant displaced into the maxillary sinus: technical note

Minimal invasive endoscopic surgery has been developed for various indications in the cranio-maxillofacial area. In this article, a technique for endoscopic removal of a dental implant displaced into the maxillary sinus is presented. Access to the implant was achieved transorally via the canine fossa. The implant was captured and removed using a urological retrieval basket through the endoscopic working channel port. The endoscopic surgical approach described was reliable and minimally invasive for removing dental materials displaced into the maxillary sinus.

Mast cell chymase expression inHelicobacter pylori-associated gastritis

AIMS

To study the role of mast cell chymase in the inflammatory processes of human chronic gastritis. Experimental studies have shown that mast cell chymase stimulates inflammatory cell accumulation, and contributes to angiotensin II formation.

METHODS AND RESULTS

Tissue sections from human stomachs with Helicobacter pylori-associated gastritis (surgery/autopsy n = 20; biopsy n = 16) and normal stomachs (n = 10) were studied using immunohistochemical single and double labelling techniques. Monoclonal antibodies used were directed against mast cell chymase, tryptase, neutrophils (CD66b, elastase, and myeloperoxidase), macrophages, T-lymphocytes, and interleukin (IL)-4. The expression of angiotensin-converting enzyme and angiotensin II type 1 receptor was investigated using immunohistochemical analysis and the reverse transcription-polymerase chain reaction. The number of chymase-positive mast cells was significantly higher (P < 0.0001) in H. pylori-associated gastritis than in normal stomachs. Increased expression of chymase in inflamed mucosa was closely related to an increase in the accumulation of neutrophils, macrophages, T-lymphocytes, and IL-4-positive cells. The expression of angiotensin-converting enzyme and angiotensin II type 1 receptor was not altered in gastritis specimens.

CONCLUSIONS

These observations suggest that mast cell chymase may be an important mediator in the inflammatory processes of human H. pylori-associated gastritis.

TGF-beta 3 decreases type I collagen and scarring after labioplasty

Cleft lip is a common congenital malformation, and labioplasty performed on infants to repair such defects often results in severe scar formation. Since TGF-beta 3 has been implicated in wound healing, we therefore hypothesized that TGF-beta 3 functions to reduce scarring after cleft lip repair. In this investigation, we demonstrated that exogenous TGF-beta 3 reduced scar formation in an incised and sutured mouse lip in vivo. During labioplasty, endogenous TGF-beta 3 expression was also elevated. In vitro experiments showed that exogenous TGF-beta 3 reduced type I collagen accumulation. Furthermore, TGF-beta 3 inhibited alpha-smooth-muscle actin expression, a marker for myofibroblasts. In tandem, TGF-beta 3 induced the expression and activity of MMP-9. Analysis of our data suggests that TGF-beta 3 is normally secreted following labioplastic wound healing. An elevated level of TGF-beta 3 reduces type I collagen deposition by restricting myofibroblast differentiation and thereby collagen synthesis, and by promoting collagen degradation by MMP-9. In combination, these events lead to TGF-beta 3-mediated reduced scar formation.

Platelet-derived growth factor and bone morphogenetic protein in the healing of mandibular fractures in rats

We studied the effects of platelet-derived growth factor-B (PDGF-B) and bone morphogenetic protein-2 (BMP-2) during the healing of mandibular closed fractures in rats by immunohistochemical methods. Unilateral closed fractures were created in the mandibles of thirty 12-week-old rats. BMP-2 was expressed during all stages of healing, but PDGF-B was expressed mainly in the early and middle stages, and not in the later stage of the healing process. We conclude that PDGF-B was associated with the proliferation and migration of primitive mesenchymal cells. BMP-2 was related to the differentiation of mesenchymal cells into osteoblasts and chondroblasts. PDGF-B and BMP-2 both have distinct regulatory effects on the healing of fractures.