P6251Prognostic value of ACEi/ARBS in elderly patients with heart failure with reduced ejection fraction with and without chronic kidney disease

Introduction

Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers therapy (ACEI/ARB) have shown to reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF). However, there is lack of information about the benefit of these drugs in patients with chronic kidney disease (CKD), and even less in elderly patients. Our aim is to compare the prognostic impact of ACE/ARB if CKD is present or not

Methods

From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. Clinical, echocardiographic and ECG data were taken from hospital records. Follow-up was made via telephone and hospital records as well. We analyzed the relationship between treatment with ACEi/ARBs (with different doses) and occurrence of mortality or MACE (major adverse cardiovascular events: composite of death from any cause or hospitalization for heart failure).

Results

From the total population 410 (51%) patients that had not CKD (glomerular filtration rate (GFR) >60ml/min/1,73m2) and 390 (49%) patients had CKD (with GFR ≤60ml/min/1,73m2). We analyze the population according the presence or not of CKD. Both groups had similar characteristics except the age: 81.5±4.5 years vs. 82.6±4.1 (p<0.05) and the percentage of use of ACEi/ARB 78.8% of the total vs 66.9% of the total (p<0.05). The mean ejection fraction was 27.9±6.5% vs 28.12±6.5% (p>0.05). The mean follow up was 33±22 vs 32±23 months (p>0.05). In patients with no CKD 170 (42%) patients died and 239 (58%) patients had a MACE. In the CKD group 211 (54.1%)patients died and 257 (65.9%)patients had a major cardiovascular event. In the univariate analysis in both groups the use of ACEi/ARB reduced the mortality and the MACE. After a multivariate analysis ACEi/ARB appear to be beneficial in the CKD group (OR 0.71 [0.50–0.98]) but not in no CKD group

Conclusions

According to our data, treatment with ACEI/ARB in elderly patients HFrEF and CKD should be encouraged even more than in those without CKD.

Characterization of Water-Extractable Pentosans in Enzyme-Supplemented Wheat Sourdough Processes

Effects of white wheat flour, sourdough starters (multiform and pure strain) and enzymes (amylase/pentosanase and/or lipase) on composition of water-extractable pentosans during bread making were evaluated. Gel permeation chromatography of purified water-extractable pentosans (WEP) yielded five fractions with apparent molecular weight (MW) comprised between 3.8 x 10' and 102 Daltons. WEP isolated from dough and bread samples had the same MW distribution but different relative proportion of each fraction. Addition of commercial hemicellulases significantly increased the formation of WEP with MW between 3.8 x 10' and I x 10' D. This increment depended on the starter used. The addition of enzyme to sourdough samples significantly decreased protein content in WEP fractions at every bread-making stage and ferulic acid content after mixing and fermentation.

Influence of enzymes in sourdough wheat breadmaking. Changes in pentosans / Influencia de las enzimas y los iniciadores microbianos en panificación. Cambios en las pentosanas

The effect of the joint use of sourdough and enzymes in breadmaking on total, soluble and insoluble pentosans, and composition of water extractable pentosans was studied. Two wheat flours of differ ent baking quality, two commercial starters (a pure strain of Lactobacillus sanfranciscensis and the multiform starter Böcker) and two commercial enzymes (pentosanase/amylase, lipase, and their com bination) were included in the study. The presence of sourdough starters modified the amount of water extractable pentosans, promoting a solubilization at the dough stage and insolublization dur ing baking, as well as a greater degree of arabinose substitution. Flour and enzymes interacted along the different stages of the process. The pentosanase/amylase increased extractability of pentosans depending on the endogenous pentosan structure of either flour. Both flours showed different degrees of arabinose substitution, which was modified by enyzme treatment, mainly during baking.

Effects of the combination of starters and enzymes in regu lating bread quality and shelf life Effectos de la combinación de iniciadores microbianos y enzimas en la calidad y conservación del pan

The influence of commercial enzymes and starters on white wheat bread quality and keeping proper ties (microbial and physical shelf life) has been studied. Two different quality flours, two enzymes (α- amylase/pentosanase, lipase and their mix), and three microbial starters were used to formulate twenty four breads. The combination of enzymes and starter resulted in beneficial effects greater than those obtained when each technological aid was used in a single way. The effect was mostly stressed when low grade wheat flour was used; in this case, specifically designated combinations facilitated loaves of improved volume and shape, and a crumb texture with initial values and rate of staling close to those found with a high quality flour.

Effects of growth hormone (GH) replacement and cognitive rehabilitation in patients with cognitive disorders after traumatic brain injury

OBJECTIVE

To assess the effects of growth hormone (GH) treatment combined with cognitive rehabilitation in patients with adult growth hormone deficiency (GHD) and cognitive disorders occurring after traumatic brain injury (TBI).

PARTICIPANTS

Nineteen adult patients with TBI: GHD was found in 11 of them.

INTERVENTION

Patients were treated with GH (GHD; sc; 1 mg/day) or vehicle (controls; sc; 1 mg/day); daily cognitive rehabilitation therapy was performed in both groups for 3 months.

MAIN OUTCOME MEASURES

The GHRH-arginine test established GHD. The neuropsychological test WAIS was performed before commencing the treatment and 3 months after commencing it.

RESULTS

Controls achieved significant improvements in digits and in manipulative intelligence quotient (IQ) (p < 0.05 vs. baseline). GHD achieved significant improvements in more cognitive parameters: understanding, digits, numbers and incomplete figures (p < 0.05 vs. baseline) and similarities, vocabulary, verbal IQ, manipulative IQ and total IQ (p < 0.01). GHD reached significantly greater improvements than controls in similarities (p < 0.01) and in vocabulary, verbal IQ and total IQ (p < 0.05).

CONCLUSION

GH administration significantly improved cognitive rehabilitation in GHD patients. Since at the end of treatment period plasma IGF-I levels were similar in both groups it is likely that exogenous GH administration is responsible for the significant differences found.

[Spinal cord ischemia as a consequence of dissection of an abdominal aortic aneurysm]

INTRODUCTION

Ischemic spinal cord infarct is the most frequent vascular lesion, but although aortic aneurysms are a possible cause, it is unusual for such cases to be seen. Clinical case. We present a case of spinal ischemia as the first sign of the dissection of an aneurysm of the abdominal aorta. A 58 year old man was seen in the hospital Emergency Department complaining of lumbar pain and the sudden onset of paraplegia of the legs, associated with pain in the middle of his back but with no history of previous trauma or effort. The only relevant personal history was of smoking. Whilst he was in the Neurology Department, the anomaly was diagnosed after dorsal, and lumbar gadolinium magnetic resonance (MR), when a zone of ischaemia at T9-T10 was seen and, as a casual observation, an image compatible with an aneurysm of the abdominal aorta. The relationship between the dissection of the aorta and the neurological complications may be explained by a clear understanding of the vascular supply to the spinal cord. In this case, both the clinical findings and the MR were clearly indicative of an anterior spinal artery syndrome.

CONCLUSIONS

In spite of its rarity, aortic aneurysm should be included in the differential diagnosis of a clinical picture of ischemic myelopathy, especially when there is lumbar and/or abdominal pain before the appearance of neurological symptoms. Spinal MR is important for this diagnosis.

Biosynthesis and maintenance of GSH in primary astrocyte cultures: role of L-cystine and ascorbate

We have studied the optimal conditions to maintain the astrocyte GSH levels under normal and oxidative stress conditions. The rate of GSH synthesis from L-methionine was statistically lower than from L-cystine or N-acetyl-cysteine in astrocytes treated with diethyl-maleate, which is a substrate of GSH S-transferases. This is in accordance with the fact that cystathionase activity was not detectable. The transport of L-cystine mediated by the Na(+)-independent system Xc- is the limiting step in GSH synthesis in astrocytes. Incubation with tert-butyl hydroperoxide (t-booH) reduced GSH concentration in astrocytes. This reduction was ameliorated in part by the addition of ascorbate or dehydroascorbate. When L-cystine and ascorbate were added together to the t-booH-treated astrocytes, the GSH concentration was indistinguishable from controls. Electron micrographs of astrocytes treated with t-booH showed an increased number of vacuoles and mitochondrial swelling. This was prevented by ascorbate and dehydroascorbate. The physiological implications of the availability of GSH precursors and ascorbate in the maintenance of GSH in astrocytes are discussed.

Hepatic amino acid uptake is decreased in lactating rats. In vivo and in vitro studies

To study the redistribution of amino acids to the mammary gland during lactation we used lactating and virgin rats fed liquid diets. Virgin rats were divided in two groups: one group was fed daily a diet containing the same amount of protein that was consumed the previous day by lactating rats (high protein diet-fed rats), and the other virgin group was fed the normal liquid diet (control). The hepatic availability of amino acids was significantly higher in the lactating rats than in the other two groups, but the uptake and fractional extraction of amino acids by the liver were lower in lactating rats than in the high protein-fed virgin controls. When primary hepatocyte cultures were used, the uptake of 2-amino-[1-14C]isobutyric acid (AIB) and the activity of system A were found to be significantly higher in the hepatocytes from virgin rats fed the high protein diet than in those obtained from the lactating and control virgin groups. No difference was observed between the control virgin rats and the lactating rats. The kinetic of AIB showed that the Vmax/Km ratio was significantly lower in hepatocytes from lactating rats than in those from the high protein diet-fed virgin rats. Addition of prolactin to the incubation medium decreased the uptake of AIB in hepatocytes from both groups of virgin rats. Moreover, uptake of AIB was greater in bromocriptine-treated lactating rats and in lactating rats that had had their pups removed for the preceding 24 h compared with values for the lactating rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Glutathione metabolism in primary astrocyte cultures: flow cytometric evidence of heterogeneous distribution of GSH content

The time-course of intracellular glutathione (GSH) values after incubation with L-buthionine-(S,R)-sulfoximine (BSO), a selective inhibitor of gamma-glutamylcysteine synthetase, showed that glutathione turns over with a half-life of 5 h. Intracellular GSH was assayed by flow cytometry using three different methods. Astrocytes showed a narrow range of cellular size but a wide range of intracellular GSH. This heterogeneity was resolved into three distinct subpopulations which represent 20%, 35% and 45% of the total astrocyte number. The less abundant subpopulation had the lower GSH content, while the most abundant was the subpopulation with the higher content. Over 95% of astrocytes were in the G0/G1 phase of the cell cycle, the distribution of cytosolic pH was homogeneous and the number of viable cells at the time of the assay was 90%. These results show that several pools exist when astrocyte GSH is considered and these findings may be relevant to the understanding of brain GSH metabolism.