Prognostic usefulness of arm circumference and nutritional screening tools in older patients with cardiovascular disease.

BACKGROUND AND AIM: Arm circumference (AC) and nutritional screening tools have been shown to have prognostic capability in patients with cardiovascular disease (CVD). This study aimed to compare the prognostic predictive capabilities of AC and nutritional screening tools in older patients with CVD. METHODS AND RESULTS: The study population consisted of 949 admitted patients ≥60 years old with CVD. Patients underwent AC measurement and nutritional screening before hospital discharge. We used the controlling nutritional status index (CONUT), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) as nutritional screening tools. The end point of the study was all-cause mortality. The mean age of the study population was 72.3 ± 7.2 years, and 68.2% of the patients were male. A total of 130 deaths occurred over a median follow-up period of 2.2 years (interquartile range, 1.1-3.8 years). After adjusting for other prognostic factors, AC (hazard ratio [HR]: 0.59; p < 0.001), CONUT (HR: 0.82; p = 0.016), GNRI (HR: 0.77; p = 0.040), and PNI (HR: 0.80; p = 0.014) were significant predictors of mortality. However, adding AC to the multivariate-adjusted model (0.739 vs. 0.714, respectively; p = 0.037), but not CONUT, GNRI, or PNI (0.724, 0.717, and 0.723 vs. 0.714; p = 0.072, p = 0.306, and p = 0.127, respectively), significantly increased the area under the curve on receiver operating characteristic curve. CONCLUSIONS: AC, but not nutritional screening tools, plays a complementary role to preexisting prognostic factors for predicting prognosis in older patients with CVD.

Structure-activity studies on nociceptin analogues: ORL1 receptor binding and biological activity of cyclic disulfide-containing analogues of nociceptin peptides.

Nociceptin/Orphanin FQ is an endogenous peptide ligand for the opioid receptor-like 1 (ORL1) receptor. To investigate the structural and conformational requirements of the nociceptin (NC)-receptor interaction, six cyclic analogues containing Cys disulfide linkages were designed and synthesized. Analogues cyclized at the N-terminal part, cyclo[Cys(0), Cys(7)]NC(1-13)-NH(2) (2) and cyclo[Cys(0), Cys(11)]NC(1-13)-NH(2) (4), and their corresponding linear peptides had very low activities in both the receptor binding and the GTP gamma S functional assays using human ORL1 transfected cell membranes. On the contrary, analogues cyclized at the C-terminal parts by the disulfide linkages at positions 6-10, 7-11, 7-14, and 10-14 sustained relatively high potencies in both assays. Notably, cyclo[Cys(10), Cys(14)]NC(1-14)-NH(2) (12) was found to be a potent NC agonist nearly as active as the parent peptide or NC. The maximum efficacy (Emax) of the C-terminally cyclized analogues and their linear counterparts in the GTP gamma S functional assay showed more than 94% (vs NC as 100%), suggesting that these analogues are full agonists. Analogue 12 is the first conformationally constrained NC analogue with almost full activity, and thus may serve to analyze the bioactive conformations of NC at the receptor site as well as serving as a template for more potent NC agonists.

[Usefulness of three-dimensional color Doppler sonography for the differential diagnosis of subpleural lesions].

The purpose of our investigation was to assess the usefulness of three-dimensional color Doppler sonography (velocity mode and power mode) for the differential diagnosis of subpleural lesions. Thirty lesions (11 pneumonias, 5 lung abscesses, 11 primary lung cancers, 3 metastatic lung cancers) were examined. Three-dimensional images were reconstructed by a maximum intensity projection method. Three-dimensional representations of intralesional blood flow became available for all lesions approximately 11 seconds after scanning. In every case, the entire vasculature of the tumor, the pneumonia, the abscess, or the inflamed region of the lung was appreciated more easily from three-dimensional images than from two-dimensional images. We classified the color flow pattern of subpleural lesions depicted by color flow imaging into seven groups. Color flow was depicted better by the three-dimensional color Doppler power mode than the velocity mode. Three-dimensional color flow patterns observed in power mode, patterns of the pneumonias and the lung cancers differed significantly. Our results suggest that the three-dimensional color Doppler power mode is useful for the differential diagnosis of subpleural lesions.

Lesions of bone and bone marrow in myeloid leukosis occurring naturally in adult broiler breeders.

Lesions of bone and bone marrow in myeloid leukosis (ML) occurring naturally in adult broiler breeders were investigated pathologically. During gross examination, nodules and protrusions were commonly observed on the surface of the sternum, ribs, vertebrae, and synsacrum. The bone marrow of all the bones of the body was pale in color. Histologically, granulated myelocytes proliferated in the bone marrow of various bones and in the periosteum of the sternum, ribs, vertebrae, and synsacrum. The first proliferation of tumor cells occurred in the bone marrow of epiphysis. The myelocytes invaded through haversian and Volkmann's canals from the bone marrow to periosteal areas. Hematopoiesis was suppressed by marked proliferation of tumor cells in the bone marrow of the whole bone. Atrophy was also seen in the bones, including medullary bones of the chickens suffering from ML. Proliferation of myelocytes was seen in the bone marrow and periosteum of ossified cartilaginous rings of the trachea and larynx. Marked proliferation of myelocytes was seen in the dura mater of spinal cords, and it subsequently depressed the spinal cords. Bone formation with cartilage was seen in the periosteum of the sternum having marked proliferation of myelocytes in the bone marrow and periosteum. Ultrastructurally, tumor cells showed large nuclei and cytoplasm with large round electron-dense lysosomes. The virus particles were rarely detected in the cytoplasm of tumor cells. The polymerase chain reaction test of tumor samples showed positive for subgroup J avian leukosis virus. This study indicates that the myelocytes can invade through the compact bones to the periosteum in the sternum, ribs, vertebrae, synsarcum, and ossified cartilage of trachea and larynx having thinner compact bones. In addition, the periosteal osteogenesis with cartilage in the sternum may be reactive change against the bone atrophy because of the marked proliferation of myelocytes.

Dual-viral vector approach induced strong and long-lasting protective immunity against very virulent infectious bursal disease virus.

To induce strong protective immunity against very virulent infectious bursal disease virus (vvIBDV) in chickens, two viral vector systems, Marek's disease and Fowlpox viruses expressing the vvIBDV host-protective antigen VP2 (rMDV, rFPV), were used. Most of chickens vaccinated with the rFPV or rMDV alone, or vaccinated simultaneously with both at their hatch (rMDV-rFPV(1d)), were protected against developing clinical signs and mortality; however, only zero to 14% of the chickens were protected against gross lesions. In contrast, gross lesions were protected in 67% of chickens vaccinated primarily with the rMDV followed by boosting with the rFPV 2 weeks later (rMDV-rFPV(14d)). Protection against the severe histopathological lesions of rFPV, rMDV, rMDV-rFPV(1d), and rMDV-rFPV(14d) vaccine groups were 33, 42, 53, and 73%, respectively. Geometric mean antibody titers to VP2 of chickens vaccinated with the rFPV, rMDV, rMDV-rFPV(1d), and rMDV-rFPV(14d) before the challenge were 110, 202, 254, and 611, respectively. Persistent infection of the rMDV in chickens after the booster vaccination with rFPV was suggested by detection of the rMDV genes from peripheral blood lymphocyte DNA at 28 weeks of age. These results indicate that the dual-viral vector approach is useful for quickly and safely inducing strong and long-lasting protective immunity against vvIBDV in chickens.

[Usefulness of power Doppler sonography for the assessment of subpleural lesions].

We investigated the usefulness of color Doppler power mode imaging for the assessment of subpleural lesions in 48 patients (27 with pneumonia, 4 with pulmonary abscesses, 12 with primary lung cancer, and 5 with metastatic lung cancer). We classified the patterns obtained by color flow imaging of subpleural lesions into six groups: type 0, no color flow; type I, spotty color flow; type II, linear color flow; type III, branchy color flow; and type IV, tortuous color flow, with type IV-A, for partial tortuous flow and type IV-B, for general tortuous flow. The color Doppler power mode proved better than velocity mode in terms of ability to generate clear color flow patterns. Color flow patterns obtained in power mode on the patients with pneumonia differed significantly from the patterns obtained on the lung cancer patients. Although the color flow patterns observed in power mode differed significantly for the benign and malignant groups, no statistically significant differences were observed in velocity mode. These findings illustrated the usefulness of color Doppler power mode imaging as a means of diagnosing benign and malignant subpleural lesions.

[Left and right ventricular diastolic properties in essential hypertension during cold pressor test: noninvasive assessment by pulsed Doppler echocardiography].

The diastolic properties of the left and right ventricles of 17 essential hypertensive patients (HT) without left ventricular hypertrophy and of 12 normotensive subjects were assessed by pulsed Doppler echocardiography during the cold pressor test (CPT) and after administration of nifedipine (10 mg). The results were as follows: 1. The peak blood flow velocities due to the left and right atrial contractions (ALV, ARV) at rest in the HT group were significantly greater (p less than 0.001) than those in the control group. The ratios of peak velocities due to atrial contraction and rapid filling of each ventricle (A/R) in the HT group were significantly increased (p less than 0.001) compared with those of the controls. 2. The peak rapid filling flow velocity of each ventricle during cold pressor test in the HT group was significantly less and the A/R of each ventricle was significantly (p less than 0.001) greater compared to those at rest. 3. Diastolic indices and systolic blood pressure did not change significantly after administration of nifedipine at rest or during cold pressor test. These results indicate that abnormal diastolic properties of the left and right ventricles are further deteriorated by increasing afterload.

[Relationship between left ventricular diastolic behavior and the A wave ratio by the apexcardiogram: a study with echocardiography and pulsed Doppler echocardiography].

We investigated the relationship between parameters of left ventricular diastolic filling using pulsed Doppler echocardiography and the A wave ratio of apexcardiography (ACG), and then evaluate the characteristic features of diastolic behavior in hypertrophic hearts and in various cardiac diseases. The study population consisted of 68 patients and 25 normal subjects, and included 19 cases of chronic renal failure (CRF), 17 cases of ischemic heart disease (IHD), 16 cases of hypertension (HT), six cases of hypertrophic cardiomyopathy, two cases of aortic stenosis, two cases of arrhythmias, and six of other cardiac diseases. The A wave ratio of ACG was calculated as the ratio of A wave amplitude and total excursion [(A/E-O) x 100]. At the same time, the peak early filling velocity (R), the peak late filling velocity (A), the ratio of R to A (A/R), acceleration time (AT), and deceleration time (DT) were measured from the left ventricular inflow velocity pattern using pulsed Doppler echocardiography. The results were as follows: 1. There was a close positive correlation between the A wave ratio of ACG and the A/R of pulsed Doppler echocardiography. 2. In patients with left ventricular hypertrophy (LVH), both the A wave ratio and the A/R were significantly higher than those in normal subjects. And in LVH with asynergy, both the A wave ratio and the A/R were significantly higher than those in LVH without asynergy. 3. In CRF, IHD, and HT, both the A wave ration and the A/R were significantly higher than those in normal subjects, but there were no significant differences among these three disease entities.(ABSTRACT TRUNCATED AT 250 WORDS)