Long term outcome of patients suffering from cancer and Takotsubo syndrome or myocardial infarction

BACKGROUND

The pathophysiology of takotsubo syndrome (TTS) is unclear so far. There is strong association of the occurrence of TTS and malignant diseases. An association between malignant diseases and myocardial infarction (MI) was found recently and ascribed to common molecular and lifestyle mechanisms.

AIM

To compare the outcome of patients with MI or TTS and malignant diseases in a matched cohort.

METHODS

Patients with TTS or with MI (n = 138 per group) were matched for age and sex and assessed retrospectively and prospectively. Occurrence of malignant diseases and clinical outcome was followed up over 4 years.

RESULTS

At the time of the index event, 8 (5.8%) MI patients and 17 (12.3%) TTS patients were already diagnosed with cancer. During follow up, the rate of patients who developed cancer was significantly higher in the TTS group than in the MI group (log rank P = 0.01). Mortality was higher in the TTS group, but also in the subgroup of TTS patients with cancer (log rank P < 0.05). In the multivariate analysis, male gender, renal impairment and the history of cancer was associated with an increased risk for death.

CONCLUSIONS

Patients with TTS have more often malignant diseases than patients with MI. Cancer patients with TTS have a worse clinical outcome. The underlying mechanism is unclear yet, but the results point at TTS being the syndrome of an extracardiac disease rather than a disease of cardiac origin. Longer and closer follow up of patients with TTS and further studies addressing the mechanism of TTS are needed.

Percutaneous Closure of Left Atrial Appendage significantly affects Lipidome Metabolism

Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.

Correction to: Occlusion of left atrial appendage affects metabolomic profile: focus on glycolysis, tricarboxylic acid and urea metabolism

The article Occlusion of left atrial appendage aff ects metabolomic profile:focus on glycolysis, tricarboxylic acid and urea metabolism, written by K. Sattler, M. Behnes, C. Barth, A. Wenke, B. Sartorius, I. El-Battrawy, K. Mashayekhi, J. Kuschyk, U. Hoffmann, T. Papavasiliu, C. Fastner, S. Baumann, S. Lang, X. Zhou, G. Yücel, M. BorggrefeI, Akin, was originally published Online First without open access.

Occlusion of left atrial appendage affects metabolomic profile: focus on glycolysis, tricarboxylic acid and urea metabolism

BACKGROUND

Left atrial appendage (LAA) closure (LAAC) by implantation of an occlusion device is an established cardiac intervention to reduce risk of stroke while avoiding intake of oral anticoagulation medication during atrial fibrillation. Cardiac interventions can alter local or systemic gene and protein expression. Effects of LAAC on systemic metabolism have not been studied yet.

OBJECTIVES

We aimed to study the effects of interventional LAAC on systemic metabolism.

METHODS

Products of glycolysis, tricarboxylic acid and urea metabolism were analyzed by ESI-LC-MS/MS and MS/MS using the AbsoluteIDQ™ p180 Kit in plasma of 44 patients undergoing successful interventional LAAC at baseline (T0) and after 6 months (T1).

RESULTS

During follow up, plasma concentrations of several parameters of glycolysis and tricarboxylic acid cycle (TCA) and urea metabolism increased (alanine, hexose, proline, sarcosine), while others decreased (aspartate, glycine, SDMA, serine). Multivariate linear regression analysis showed that time after interventional LAAC was an independent predictor for metabolite changes, including the decrease of SDMA (beta -0.19, p < 0.01) and the increase of sarcosine (beta 0.16, p < 0.01).

CONCLUSIONS

Successful interventional LAAC affects different pathways of the metabolome, which are probably related to cardiac remodeling. The underlying mechanisms as well as the long term effects have to be studied in the future.

Single- and multiple-dose pharmacokinetics of repaglinide in patients with type 2 diabetes and renal impairment

OBJECTIVE

The primary objective of this single-centre, open-label, parallel-group study was to evaluate the pharmacokinetics and safety profile of the prandial glucose regulator repaglinide, following single and multiple dosing, in patients with type 2 diabetes with and without varying degrees of renal impairment.

METHODS

The study comprised three screening visits, followed by a 7-day inpatient period. Thirty-four patients, with normal renal function (n = 12), mild-to-moderate renal dysfunction (n = 12) or severe renal dysfunction (n = 10), received a single 2-mg dose of repaglinide on day 1, followed by preprandial 2-mg doses with main meals (breakfast, lunch and dinner) on each of days 2-4. A final 2-mg dose of repaglinide was administered on day 5.

RESULTS

Patients with mild-to-moderate renal impairment showed no significant differences in the pharmacokinetics of repaglinide, compared with patients with normal renal function. In the group of patients with severe renal dysfunction, the main pharmacokinetic finding was a longer half-life after multiple dosing. Rates of minor hypoglycaemia were similar in patients with severe, mild-to-moderate and no renal dysfunction. No major hypoglycaemic episodes occurred.

CONCLUSION

Patients with type 2 diabetes and mild or moderate impairment of renal function may be treated with repaglinide without special precautions. If repaglinide is used in patients with severely impaired renal function, dose adjustment may be necessary if indicated by blood glucose measurements.

Single- and multiple-dose pharmacokinetics of repaglinide in patients with type 2 diabetes and renal impairment

OBJECTIVE

The primary objective of this single-centre, open-label, parallel-group study was to evaluate the pharmacokinetics and safety profile of the prandial glucose regulator repaglinide, following single and multiple dosing, in patients with type 2 diabetes with and without varying degrees of renal impairment.

METHODS

The study comprised three screening visits, followed by a 7-day inpatient period. Thirty-four patients, with normal renal function (n = 12), mild-to-moderate renal dysfunction (n = 12) or severe renal dysfunction (n = 10), received a single 2-mg dose of repaglinide on day 1, followed by preprandial 2-mg doses with main meals (breakfast, lunch and dinner) on each of days 2-4. A final 2-mg dose of repaglinide was administered on day 5.

RESULTS

Patients with mild-to-moderate renal impairment showed no significant differences in the pharmacokinetics of repaglinide, compared with patients with normal renal function. In the group of patients with severe renal dysfunction, the main pharmacokinetic finding was a longer half-life after multiple dosing. Rates of minor hypoglycaemia were similar in patients with severe, mild-to-moderate and no renal dysfunction. No major hypoglycaemic episodes occurred.

CONCLUSION

Patients with type 2 diabetes and mild or moderate impairment of renal function may be treated with repaglinide without special precautions. If repaglinide is used in patients with severely impaired renal function, dose adjustment may be necessary if indicated by blood glucose measurements.

Specificity of circulating and tissue-bound autoantibodies in Goodpasture syndrome

Goodpasture syndrome is an often fatal autoimmune disease associated with glomerulonephritis and/or pulmonary hemorrhage. The clinical manifestations of this disease correlate well with the presence of circulating antiglomerular basement membrane (GBM) autoantibodies. The primary target antigen in glomerular and alveolar basement membranes is thought to be the alpha 3 chain of type IV collagen. Nearly all that is known about anti-GBM antibodies in humans comes from work on unbound circulating antibody. We recently had the unique and rare opportunity to obtain early postmortem antibody and tissues from a patient who died with catastrophic Goodpasture syndrome. The specificity of circulating, kidney-bound and lung-bound autoantibodies from this patient was evaluated against a variety of purified basement membrane constituents. The results indicate that the primary target for the circulating and tissue-bound autoantibodies is the NC1 domain of the alpha 3(IV) chain of type IV collagen. Additionally, all the antibodies recognize a cryptic epitope/s on the alpha 3(IV)NC1 hexamer. Furthermore, tissue-bound and circulating antibodies compete with one another for overlapping epitopes on the antigen. These findings demonstrate that circulating autoantibodies in Goodpasture syndrome are highly representative of those bound to organ tissues, strengthening the notion that pathogenic autoantibodies are targeted to the alpha 3(IV)NC1 collagen, and that previous reports of findings in the circulation may be applicable to tissue injury.

Vapor-Condensation Generation and STM Analysis of Fullerene Tubes

Fullerene tubular structures can be generated by vapor condensation of carbon on an atomically flat graphite surface. Scanning tunneling microscope (STM) images revealed the presence of tubes with extremely small diameters (from 10 to 70 angstroms), most of which are terminated by hemispherical caps. Atomic resolution images of such structures showed that the tubes have a helical graphitic nature. The formation of the tubes under the quasi-free conditions suggests that the growth to tubular rather than spherical configurations is preferred for "giant fullerenes."

[Preparation of preoral sustained-release preparations with a base of biodegradable polymers. 3. Preparation of matrix tablets with a base of poly-3-hydroxybutyric acid]

Poly-3-hydroxybutyric acid belongs to the biological polymers, which are produced by bacterials. The determination of the grain size, moisture content, flowability and the parameters for the direct compression was performed in regard of their use as auxillary substance for the preparation of solid sustained release dosage forms. The production of the matrix tablets was performed on the basis of a factorial design. The content of substance, an addition of Heweten 12 and the compression power served as factors. Caffeine was used as model drug. The in vitro release values show, that all three factors have an influence of the drug release. Optimized matrix tablets were produced on the basis of this result.

[Evaluation of hearing improvement due to hearing aids]

A method to assess the hearing improvement due to hearing aids is described. This method has been used routinely at a local hospital for 2 years on 200 patients. This method is based on the assessment of the speech reception threshold for sentences ("Marburger Satztest") in silence and in various noise levels (speech simulating noise). The following were used for the assessment of the hearing aid: the improvement of the speech reception threshold in silence with or without a hearing aid, the maximum tolerable noise level (i.e. the noise level at which everyday speech becomes subliminal for patients with hearing aids) and the noise level at which the speech reception threshold with the hearing aid is worse than without.

[Acetobacter methanolicus--a new organism for genetic studies]

A new bacterial strain is described belonging to Acetobacter methanolicus species. It is of industrial value as a producer of protein and methanol products. The strain is acidophile and this feature comprises a conspicuous technological advantage. The results of bacteriophage and cell interactions are reported. They might be potentially useful for elaboration of the transduction technique for the strain. The collection of mutants was obtained including those utilizing methanol, having auxotrophic markers as well as streptomycin and rifampicin resistances. The transfer of plasmids RSF1010 and R68 to Acetobacter methanolicus from other bacteria has been demonstrated.

Signal-to-noise threshold with and without hearing aid

We determined the necessary signal-to-noise threshold for 50% sentence discrimination in 130 patients with sensorineural hearing disorders with and without a hearing aid, as well as the minimum monosyllable discrimination loss without hearing aid. A significant correlation coefficient was found to exist of the signal-to-noise threshold with vs. that without hearing aid (r = 0.61), and between the minimum discrimination loss and the signal-to-noise threshold with hearing aid (r = 0.38). These differences in the correlation coefficient indicate that the impairment of speech perception in noise when using a hearing aid is obviously due to the deterioration of the signal-to-noise threshold induced by the hearing loss rather than to the discrimination loss per se.

[An epidemiological study of endometrial cancer. Controlled trial of 501 cases (author's transl)]

In a retrospective case control study, 501 cases of endometrial cancer were observed from 1955-1975 and an equal number of matched control cases were compared regarding the following parameters: obesity, hypertension, diabetes, age a menopause, parity, age at first and last delivery, age at menarche, menstrual abnormalities, history of prior endometrial biopsies, concomitant ovarian tumours, family history of cancer and history of exposure to radiation. The statistical analysis revealed significant differences regarding the incidence of obesity, hypertension, late menopause, low parity, prior endometrial biopsies and prior exposure to ionizing radiation. However, no significant difference was found between endometrial cancer patients and control patients as to the incidence of diabetes, age at menarche, age at first delivery and family history of cancer. The results of the investigation are discussed and compared with similar reports from the literature.

Results of alloarthroplasty of the hip joint

We report on the follow-up examination results of 881 operated hip joints which were implanted in the Innsbruck University Clinic for Orthopedics during the period 1968--1975. Due to exact checking 75% of all patients could be clinically control-examined during 1978 and all available information regarding the others was collected. In the patient group with an average age of 62.5 years the course of postoperative mobility over the years was mainly examined. Functional activity, subjective patient opinion, pain, work capability and weather sensitivity were also analyzed. After an implantation period of the hip prosthesis of 3--10 years encouraging results were shown. Aseptic prostheses loosenings (9.8%) were examined with regard to their causes. The infection rate was very low at 0.56% and also periarticular calcification only occurred comparatively seldom (13.5%). Other complications were recorded in 6.8% of the patients. In total, 74% of the operated patients offered a very good or good complete result.