NLRP3 Contributes to Sarcopenia Associated to Dependency Recapitulating Inflammatory-Associated Muscle Degeneration.

Sarcopenia, a complex and debilitating condition characterized by progressive deterioration of skeletal muscle, is the primary cause of age-associated disability and significantly impacts healthspan in elderly patients. Despite its prevalence among the aging population, the underlying molecular mechanisms are still under investigation. The NLRP3 inflammasome is crucial in the innate immune response and has a significant impact on diseases related to inflammation and aging. Here, we investigated the expression of the NLRP3 inflammasome pathway and pro-inflammatory cytokines in skeletal muscle and peripheral blood of dependent and independent patients who underwent hip surgery. Patients were categorized into independent and dependent individuals based on their Barthel Index. The expression of NLRP3 inflammasome components was significantly upregulated in sarcopenic muscle from dependent patients, accompanied by higher levels of Caspase-1, IL-1ß and IL-6. Among older dependent individuals with sarcopenia, there was a significant increase in the MYH3/MYH2 ratio, indicating a transcriptional shift in expression from mature to developmental myosin isoforms. Creatine kinase levels and senescence markers were also higher in dependent patients, altogether resembling dystrophic diseases and indicating muscle degeneration. In summary, we present evidence for the involvement of the NLRP3/ASC/NEK7/Caspase-1 inflammasome pathway with activation of pro-inflammatory SASP in the outcome of sarcopenia in the elderly.

Functional continuum: independent predictor of one-year mortality and key decision-making element in older adults with severe aortic stenosis amenable to aortic valve replacement.

OBJECTIVES: The impact of functional capacity over the entire functional continuum in older adults undergoing aortic valve replacement (AVR) has not been studied to date. This study aims to analyze 1.- the distribution of a cohort of older adults presenting severe aortic stenosis (AS) amenable to AVR in the different categories of the Functional Continuum Scale (FCS); 2.- its association with decision-making regarding valve disease; and 3.- its impact upon the one-year mortality rate of surgical (SAVR), transcatheter (TAVR) aortic valve replacement, or the decision to provide conservative management (OMT). METHODS: This prospective study included patients from the FRESAS (FRailty-Evaluation-in-Severe-Aortic-Stenosis) registry evaluated by the reference Heart-Team of a region in northern Spain. All the patients underwent comprehensive geriatric assessment. RESULTS: The study comprised 257 patients aged 84.0 ± 3.9 years. MANAGEMENT: SAVR: 25.3%, TAVR: 58.0% and OMT: 16.7%. Increased patient functional capacity was associated with an increased tendency to perform more invasive valve disease treatment. The overall one-year survival rate was 81.3%. One-year all-cause mortality: FCS-1 to FCS-2 "robust" 11.5%, FCS-3 to FCS-4 "prefrail" 14.7%, FCS-5 "frail" 19.2% and FCS-6 to FCS-8 "dependent" 45.0%; p < 0.001. Adjusted mortality analysis: FCS with HR = 1.206 [95%CI, 0.999-1.451 (p = 0.051)]; EuroSCORE-II with HR = 1.071 [95%CI, 1.006-1.161 (p = 0.033)]; and OMT with HR = 2.840 [95%CI, 1.409-5.772 (p = 0.004)] were retained in the final multivariable logistic regression model. CONCLUSIONS: In older AS patients amenable to AVR, the FCS is a useful predictive tool that may aid clinical decision-making.

Frailty Assessment in a Cohort of Elderly Patients with Severe Symptomatic Aortic Stenosis: Insights from the FRailty Evaluation in Severe Aortic Stenosis (FRESAS) Registry.

BACKGROUND: Precise evaluation of the degree of frailty is a fundamental part of the global geriatric assessment that helps to avoid therapies that could be futile. Our main objective was to determine the prevalence of frailty in a specific consult of patients undergoing aortic valve replacement. METHODS: From May 2018 to February 2020, all consecutive patients ≥75 years old, with severe symptomatic aortic stenosis, undergoing valve replacement in the Principality of Asturias (Northern Spain) were evaluated. RESULTS: A total of 286 patients were assessed. The mean age was 84 ± 4.01 years old; 175 (61.2%) were female. The short performance physical battery score was 8.5 ± 2.4 and the prevalence of frailty was 19.6% (56 patients). In the multivariable analysis, age, Barthel index and atrial fibrillation were independent predictors of frailty. CONCLUSIONS: The prevalence of frailty in our sample patients undergoing aortic valve replacement, evaluated by a standardized protocol, was 19.6%.

El paciente anciano con insuficiencia cardiaca: utilidad de la ecocardioscopia en la práctica clínica diaria / The elderly patient with heart failure: usefulness of cardiac ultrasound in routine clinical practice

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Los reactantes de fase aguda en la neumonía inducida por daptomicina / Acute-phase reactants in daptomycin induced pneumonia

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Utilidad del Palliative Performance Scale v2 para la estimaciónde supervivencia en enfermos con cáncer avanzado / Usefulness of the palliative performance scale v2 (PPSv2) for estimation of survival in advanced cancer patients

Objetivo: 1) Determinar la capacidad predictiva de la escala Palliative Performance Status v2(PPSv2) para el pronóstico de supervivencia de los pacientes con cáncer avanzado. 2) Determinarlas características y la supervivencia de una cohorte de pacientes oncológicos ingresados en una Unidad de Cuidados Paliativos Hospitalaria. Material y método: estudio longitudinal prospectivo de una cohorte de 157 pacientes con cáncer con una expectativa de vida menor de tres meses. Criterios de exclusión: 1) Pacientes en situación de agonía con muerte inminente y 2) PPSv2 al ingreso mayor o igual del 80%. Variables obtenidas: edad, sexo, tipo, localización y extensión del cáncer, PPSv2 durante la valoración inicial, tiempo de supervivencia a partir del ingreso. Ámbito del estudio: unidad de cuidados paliativos de hospital universitario. Resultados: el tamaño de la muestra fue de 157 enfermos ingresados de forma consecutiva en nuestra unidad. La media de edad fue de 69,27 ± 12,24 años con una mediana de 71 años y un predominio del sexo masculino (61,8%). La localización más frecuente del cáncer fue la respiratoria (20,4%). La media y la mediana de supervivencia global fueron respectivamente19,85 días (95% IC 16,7-23,0) y 13 días (95% IC 10,3-15,7). Debido a su poco número se agruparon los casos con PPSv2 ≥ 50%. El 73,9% de los casos tenían un PPSv2

Objective: 1) to estimate the predictive value of the Palliative Performance Status Scale (PPS)for the prognosis of survival of patients with advanced cancer. 2) to clarify the profile and survival rate of a group of oncology patients admitted into a hospital palliative care unit. Material and method: A prospective longitudinal study was performed on a cohort of157 patients with cancer and an expected survival rate of less than three months. Selection criteria: patients were excluded in situation of agony with imminent death or their PPSv2 at admission was equal to or higher than 80%. Variables used were: age, sex, type of tumour, location and extension of cancer, PPSv2 on admission and survival time. Study setting: palliativecare unit of a university hospital. Results: The study included 157 patients consecutively admitted to our unit. Mean age was69.27 ± 12.24 years, with a median of 71 years and a majority of males (61.8%). The most common cancer site was the respiratory system (20.4%). The mean and median of overall survival were 19.85 days (95% CI; 16.7-23.0) and 13 days (95% CI; 10.3-15.7). Due to their small number, all the cases with a PPSv2 ≥ 50% were analysed together. Of the whole study 73% of cases had aPPSv2 < 30%, 16.6% had a PPSv2 of 40%, and 9.5% had a PPSv2 ≥ 50%. Median survival of patients with a PPSv2 of 10% was 6 days compared with 15 days for a PPSv2 of 30%, and 32 days for scores greater than 50%.Conclusions: The PPS scale on admission proved to be a useful tool to evaluate the survival of patients on palliative care. The lowest scores having a clear association with the lowest survivals. Thus, the periodical determination of the PPSv2 can be a useful prognostic tool (AU)