Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients.

BACKGROUND: Recently, serum beta2-microglobulin, an endogenous marker for renal function, has been shown to be an independent predictor of mortality in older adults. However, the prognostic role of beta2-microglobulin in heart failure has not been elucidated. METHODS: We prospectively evaluated serum beta2-microglobulin and creatinine concentrations, creatinine-based renal parameters (estimated glomerular filtration rate and creatinine clearance), and echocardiographic data in 131 patients with acute heart failure and creatinine concentrations < or =3.0mg/dL admitted to our hospitals. RESULTS: During 2.3+/-1.3 years, 42 patients died of cardiovascular causes and 12 died of noncardiac causes. Cardiovascular events were observed in 63 patients: 53 were readmitted due to worsening heart failure, 5 readmitted for cerebral embolism, and 5 died from sudden cardiac death. According to multivariate stepwise Cox proportional hazard analysis, higher baseline serum beta2-microglobulin concentrations (X(2)=16, p<0.0001), previous congestive heart failure (X(2)=11, p<0.001), presence of chronic obstructive pulmonary disease (X(2)=8, p<0.01), and lower diastolic blood pressure (X(2)=6, p<0.05) were independent predictors of increased cardiovascular events. Also, higher baseline serum beta2-microglobulin (X(2)=20, p<0.0001), lower systolic blood pressure (X(2)=11, p<0.001), higher relative left ventricular wall thickness (X(2)=6, p<0.05), and lower body mass index (X(2)=5, p<0.05) were independent predictors of increased cardiac mortality. The adjusted hazard ratio for cardiovascular events increased with baseline serum beta2-microglobulin above 2.1 mg/L: 2.9 with beta2-microglobulin of 2.2-2.6 mg/L (95%CI 1.2-6.9, p<0.05), 2.9 with beta2-microglobulin of 2.7-3.9 mg/L (95%CI 1.2-7.2, p<0.05), and 4.7 with beta2-microglobulin of > or =4.0 mg/L (95%CI 2.0-11, p<0.001). CONCLUSIONS: Higher baseline serum beta2-microglobulin concentration could be a promising risk marker in acute heart failure patients with creatinine < or =3.0 mg/dL.

[Clinical evaluation of transcatheter arterial embolization for the management of retroperitoneal bleeding in cases of pelvic fracture].

PURPOSE: We evaluated the clinical efficacy of TAE for the management of retroperitoneal bleeding in a case of pelvic fracture. MATERIALS AND METHODS: A retrospective review of 206 patients with pelvic fractures was performed. Thirty-four patients who were hemodynamically unstable or had evidence of ongoing hemorrhage required TAE. Rescue rate, effective rate, and mortality rate among the patients with multiple organ injuries were calculated. Charts were reviewed for age, Japanese coma scale (JCS), hemoglobin, blood pressures, extent of retroperitoneal hemorrhage, pelvic fracture pattern/extent of embolization, and time from judging indication of TAE to angiography. Data of patients who died of pelvic fracture hemorrhage was compared with that of others. Statistical analysis was done with analysis of variance, and the two groups were compared using Student's t-test. RESULTS: Rescue rate, success rate, and mortality rate were 76% (26/34), 91% (31/34), and 33% (8/24), respectively. Only JCS reached statistical significance. The complications of gluteal skin and muscle necrosis were experienced in one patient. Two patients with lung contusion and one patient who had suffered from idiopathic interstitial pneumonia died from disseminated intravascular coagulation associated with pneumonia. Viscorectal dysfunctions, which were observed in ten patients, were considered to be independent of TAE. CONCLUSION: TAE for pelvic fracture hemorrhage was considered effective. Complications of gluteal skin and muscle necrosis should be kept in mind.

Attenuation of biologic compensatory action of cardiac natriuretic peptide system with aging.

Although plasma B-type natriuretic peptide (BNP) levels increase with age, the mechanisms responsible for this increase are unknown. We investigated the predictors of elevated BNP in older subjects without cardiac systolic dysfunction and overt renal dysfunction. Furthermore, we analyzed the relations between BNP and its second messenger, cyclic guanosine monophosphate (cGMP), to aging. In 252 subjects (mean age 69 +/- 12 years) with left ventricular ejection fraction >/=50% and creatinine levels <==1.5 mg/dl, plasma levels of BNP, cGMP, blood urea nitrogen, creatinine, and beta2-microglobulin (an endogenous marker of renal function), estimated glomerular filtration rate, and echocardiographic data were prospectively evaluated. Plasma BNP levels increased with age (r = 0.4, p <0.0001). With use of multivariate analysis, predictors of elevated BNP levels were age, use of beta blockers, and serum beta2-microglobulin levels. The molar ratio of cGMP to BNP significantly decreased with aging (r = 0.55, p <0.0001). Elevated BNP in older subjects with normal cardiac systolic function may be due in part to renal impairment. With aging, biologic compensation of the cardiac natriuretic peptide system may be attenuated.

Epsilon-polylysine inhibits pancreatic lipase activity and suppresses postprandial hypertriacylglyceridemia in rats.

Epsilon-polylysine (epsilon-PL) has been used as a food additive in Japan for many years. In this study, it inhibited human and porcine pancreatic lipase activity in substrate emulsions containing bile salts and phosphatidylcholine, in the concentration range of 10-1000 mg/L. At the same concentrations, it also destroyed the emulsifying activity, suggesting that lipase inhibitory activity and emulsion breakdown activity were associated. Epsilon-PL inhibited porcine pancreatic lipase activity and destroyed emulsion breakdown activity at 1000 mg/L in the substrate containing bile salts and phosphatidylcholine alone. Epsilon-PL did not inhibit lipase activity or affect emulsifying activity at 1000 mg/L in the substrates containing arabic gum and polyvinyl alcohol. A comparison of lipase inhibitory activity between epsilon-PL and three types of alpha-PL with differing polymerization rates was performed. The lipase inhibitory activity of epsilon-PL was not different from that of alpha-PL (44 lysine residues). Epsilon-PL maintained its inhibitory activity after incubation with trypsin, alpha-chymotrypsin and pepsin, whereas alpha-PL did not. The effect of epsilon-PL on postprandial hypertriacylglyceridemia was investigated in rats. The plasma triacylglycerol concentration in rats intragastrically administered > or =15 mg/kg of both fat emulsion and epsilon-PL was significantly lower at 2 and 3 h after administration than that in rats administered fat emulsion alone (P < 0.05). These results strongly suggest that epsilon-PL is able to suppress dietary fat absorption from the small intestine by inhibiting pancreatic lipase activity.