Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Optimal control analysis and Practical NMPC applied to refrigeration systems

This work is focused on optimal control of mechanical compression refrigeration systems. A reduced-order state-space model based on the moving boundary approach is proposed for the canonical cycle, which eases the controller design. The optimal cycle (that satisfying the cooling demand while maximizing efficiency) is defined by three variables, but only two inputs are available, therefore the controllability of the proposed model is studied. It is shown through optimization simulations how optimal cycles for a range of the cooling demand turn out not to be achieved by keeping the degree of superheating to a minimum. The Practical NMPC and a well-known feedback-plus-feedforward strategy from the literature are compared in simulation, both showing trouble in reaching the optimal cycle, which agrees with the controllability study.

Xanthine oxidase inhibitory activity of natural and hemisynthetic flavonoids from Gardenia oudiepe (Rubiaceae) in vitro and molecular docking studies

Xanthine oxidase (XO), an enzyme widely distributed among mammalian tissues, is associated with the oxidation of xanthine and hypoxanthine to form uric acid. Reactive oxygen species are also released during this process, leading to oxidative damages and to the pathology called gout. Available treatments mainly based on allopurinol cause serious side effects. Natural products such as flavonoids may represent an alternative. Thus, a series of polymethoxyflavones isolated and hemisynthesized from the bud exudates of Gardenia oudiepe has been evaluated for in vitro XO inhibitory activity. Compounds 1, 2 and 3 were more active than the reference inhibitor, Allopurinol (IC₅₀ = 0.25 ± 0.004 μM) with IC₅₀ values of (0.004 ± 0.001) μM, (0.05 ± 0.01) μM and (0.09 ± 0.003) μM, respectively. Structure-activity relationships were established. Additionally, a molecular docking study using MOE™ tool was carried out to establish the binding mode of the most active flavones with the enzyme, showing important interactions with its catalytic residues. These promising results, suggest the use of these compounds as potential leads for the design and development of novel XO inhibitors.

Sauroxine reduces memory retention in rats and impairs hippocampal long-term potentiation generation

In the present paper it was investigated the role of sauroxine, an alkaloid of Phlegmariurus saururus, as a modulator of some types of learning and memory, considering the potential nootropic properties previously reported for the alkaloid extract and the main alkaloid sauroine. Sauroxine was isolated by means of an alkaline extraction, purified by several chromatographic techniques, and assayed in electrophysiological experiments on rat hippocampus slices, tending towards the elicitation of the long-term potentiation (LTP) phenomena. It was also studied the effects of intrahippocampal administration of sauroxine on memory retention in vivo using a Step-down test. Being the bio distribution of a drug an important parameter to be considered, the concentration of sauroxine in rat brain was determined by GLC-MS. Sauroxine blocked LTP generation at both doses used, 3.65 and 3.610^-2μM. In the behavioral test, the animals injected with this alkaloid (3.6510^-3nmol) exhibited a significant decrease on memory retention compared with control animals. It was also showed that sauroxine reached the brain (3.435μg/g tissue), after an intraperitoneal injection, displaying its ability to cross the blood-brain barrier. Thus, sauroxine demonstrated to exert an inhibition on these mnemonic phenomena. The effect here established for 1 is defeated by other constituents according to the excellent results obtained for P. saururus alkaloid extract as well as for the isolated alkaloid sauroine.

Huperzia quadrifariata and Huperzia reflexa alkaloids inhibit acetylcholinesterase activity in vivo in mice brain

Huperzine A, a Lycopodium alkaloid produced by Chinese folk herb Huperzia serrata (Lycopodiaceae), has been shown to be a promising agent for the treatment of Alzheimer's disease due to its potent acetylcholinesterase (AChE) activity, as well its efficacy in the treatment of memory of aged patients. Thus, the effects of two Huperzia species of habitats in Brazil (H. quadrifariata and H. reflexa) with described in vitro AChE inhibition activities were studied and their effects on mice brain AChE inhibition were determined after a single intraperitoneal (i.p.) injection. The alkaloid extracts were administered to mice in various doses (10, 1 and 0.5mg/kg) and acetylcholinesterase activity was measured post mortem in two brain areas using the Ellman's colorimetric method. The AChE activity was found to be significantly reduced in both the cortex and hippocampus, although this activity was less potent than that of reference inhibitor huperzine A (0.5mg/kg). Thus, it appears that H. quadrifariata and H. reflexa alkaloid extracts, shown to inhibit acetylcholinesterase in vitro, also have very potent in vivo effects, suggesting that the Huperzia species may still constitute a promising source of compounds with pharmaceutical interest for Alzheimer's disease.

Huperzia saururus increases memory retention in rats

Huperzia saururus is reported in Argentinean popular medicine as a memory improver. Chemical studies have shown that the main constituents of the species are Lycopodium alkaloids. On the basis of this information, a purified alkaloid extract was obtained by alkaline extraction of the aerial parts. The aim of this work was to investigate the effects of intra-hippocampal administration of the purified alkaloid extract (AE) on memory retention in vivo, using a step down test, in order to correlate with previous results obtained in vitro in an electrophysiological model. The AE administration significantly increased the latency time in comparison to control animals. For treated animals the latency time was 37.61 +/- 2.84, 80.94 +/- 2.37, and 180.00 +/- 5.74 s for 1, 5, and 10 ng/rat, respectively versus 14.89 +/- 2.38 s for controls. According to these results there is a good relationship between the ethnopharmacological use and the effects hereby showed.

Huperzia saururus, activity on synaptic transmission in the hippocampus

Huperzia saururus (Lam.) Trevis. (Lycopodiaceae) known as cola de quirquincho is used in folk medicine to improve memory. The cholinergic neurons of the basal forebrain, including those in the medial septum, and in the vertical limbs of the diagonal band of Broca and the nucleus basalis of Meynert, provide a major source of cholinergic enervation of the cortex and hippocampus. These neurons have also been shown to play an important role in learning and memory processes. Thus, the effects of this traditional Argentinean species were studied in relation to its activity on synaptic transmission in the hippocampus. The alkaloid extract obtained first by decoction of the aerial parts and by subsequent alkaline extraction, was purified by using a Sephadex LH 20 packed column. Electrophysiological experiments were developed with the purified extract (E(2)) on rat hippocampus slices, thus eliciting long-term potentiation (LTP). Results show a marked increase in the hippocampal synaptic plasticity. The threshold value for generation of LTP was 22 +/- 1.01 Hz on average for E(2), while for controls it was 86 +/- 0.92 Hz. All of these factors could explain the use of Huperzia saururus as a memory improver as is reported in the ethnomedicine.

Anticholinesterase activity in an alkaloid extract of Huperzia saururus

Huperzia saururus (Lam.) Trevis. (Lycopodiaceae) is used widely in Argentinian traditional medicine as an aphrodisiac and for memory improvement. An aqueous extract from the aerial parts was obtained by decoction, revealing the presence of alkaloids, among other constituents. By partition with organic solvent in alkaline media, alkaloids were extracted and then purified by gel permeation. We studied the anticholinesterase activity in vitro of the alkaloid extract using erythrocyte membranes and human serum as sources of acetylcholinesterase and pseudocholinesterase, respectively. The results show a marked inhibition of true acetylcholinesterase with an IC50 value of 0.58 microg/ml. Low inhibition of pseudocholinesterase was observed (IC50 value = 191 microg/ml). This shows a selectivity of the extract for the true acetylcholinesterase. Furthermore, chemical study of the bioactive extract was performed by GC-MS, revealing the presence of seven Lycopodium alkaloids, including some not identified previously: sauroxine, 6-hydroxylycopodine, N-acetyllycodine, lycopodine, lycodine, N-methyllycodine, and clavolonine. Further investigations will be undertaken in order to discover which compound/s are responsible for the aqueous extract's acetylcholinesterase activity.

[Paraneoplastic limbic encephalitis and lung cancer]

Paraneoplastic limbic encephalitis (PLE) is a disorder characterized by severe cognitive dysfunction and seizures. It is usually associated with small cell lung carcinoma. Diagnosis is difficult because clinical markers are often lacking, and symptoms usually precede the diagnosis of cancer. Serological detection of antineuronal antibodies can be useful. We describe a patient with symptoms of limbic encephalitis, negative for paraneoplastic antibodies, in whom lung cancer was detected.

Development of intraepithelial cells in the porcine small intestine

The number, phenotype, localisation and development of intraepithelial lymphocytes (IEL) from duodenum (Du) and ileum (Il) were studied by immunohistochemistry (IHC) and light and electron microscopy in unweaned (0-7 weeks old) and six months-old pigs. Developmental changes at birth showed that 38% of the total lymphocytes in the villi were IEL, mainly of the CD2+CD4-CD8- double negative (DN) phenotype. That proportion rose to over 50% at week 5 after birth, resembling adult proportion, although still with fewer cells than in adult pigs. CD4+ cells appeared relatively early in life although they were confined to the lamina propria (LP) and CD8+ cells were found only in low numbers. In the villi of adult animals, almost half of the total number of lymphocytes were IEL (49% Du, 52% Il). Over half of these IEL (52% Du, 53% Il) showed the CD2+CD4-CD8+ phenotype and were localized at the epithelium's basement membrane. Numerous (43% Du, 42% Il) DN IEL were found grouped at the enterocyte nucleus level and relatively few (5% in Du and Il) granular IEL were found apically in the epithelium. These proportions were homogeneously maintained along the villi's tip, middle and bottom, suggesting that the IEL may have their origin in the LP. Therefore, the IEL compartment in the porcine intestine develops slowly with age and is actually composed by a heterogeneous population of cells (null, DN and CD8+). These results may explain the increased susceptibility of young animals to disease during the lactation period and should be taken into account when functional studies are carried out with IEL. The quantitative results of this paper established a model for studies on the effect of age, diet, normal flora, infection and oral immunization on the IEL of the gut.

[Haemophilus influenzae infections in children less than 5 years of age in the community of Murcia during the 1992-1999 period]

BACKGROUND

Invasive disease due to Haemophilus influenzae has changed substantially since the introduction of the conjugated vaccine. This report studies the incidence and the clinical-epidemiological characteristics of invasive H. influenzae disease in children under five years of age during 1992-94 (before vaccination), 1995-97 (voluntary vaccination) and 1998-99 (obligatory vaccination).

PATIENTS AND METHODS

The study was performed by reviewing the clinical histories of 39 patients with H. influenzae isolates from sterile samples, according to microbiology data. The reference population's subgroup of the study, 40,322 children under 5, comprises 60% of the total in our community.

RESULTS

The overall incidence of invasive H. influenzae disease was 12.1/100,000 children under 5 and 15.7, 12.4 and 6.2 for the following periods respectively: before vaccination, during voluntary vaccination, and obligatory vaccination. All cases except one of them, were produced by H. influenzae type b and they were seen in children under 3. Meningitis accounted for more than half of the cases (51.3%). Fever was the most frequent sign (38 of 39 cases). Epiglottitis was the cause of the highest average hospital stay (20.8 days). All the patients were treated with cefotaxime, but half were also administered other antibiotics. Sequelae were seen in 7 cases, with no deaths.

CONCLUSIONS

The incidence of invasive H. influenzae disease was drastically reduced and no cases were seen in the last year. However, one vaccinated patient suffered a bacteremic etmoiditis. This case and the possibility of infection due to non-b serotypes requires ongoing surveillance for these infections.

Control of responding during stimuli that precede transitions in reinforcement frequency

Pigeons' responses were reinforced on a variant of a mixed variable-interval extinction schedule of reinforcement in which the transition to the higher reinforcement rate was signaled by a trace stimulus projected on the response key prior to the onset of the component correlated with food delivery. In the first of two experiments, the duration of the trace stimulus preceding the component correlated with food delivery was varied from 1.5 to 50.0 s and in the second experiment, the reinforcement frequency in the same component was varied from 10 to 60 reinforcers per hour. Pigeons pecked at the trace stimulus preceding the onset of the component correlated with food delivery even though responding was not reinforced in its presence and only one of the changes in reinforcement rate (i.e., from extinction to reinforcement) was signaled. The rate of pecking during the trace stimulus was a function of its duration but not of the reinforcement frequency in the following component. Higher rates generally occurred at the shorter trace-stimulus durations. Component responding following the offset of the trace stimulus was under discriminative control of the trace stimulus whether or not responding occurred in the presence of the trace stimulus.