Can we prevent or treat renal dysfunction in chronic heart failure?

We aimed to summarize the predictors of renal dysfunction and present strategies to prevent and/or treat renal dysfunction in Chronic Heart Failure (CHF). Several factors may predict renal dysfunction in CHF, including older age, comorbidities (anemia, hypertension, diabetes), severity of underlying heart disease (systolic and diastolic dysfunction, central venous pressure) as well as certain therapies in specific circumstances (diuretics, nonsteroid acute inflammatory drugs, and renine-angiotensin-aldosterone (RAAS) inhibitors). Thus, prevention of renal dysfunction is possible in CHF by treating comorbidities and underlying heart disease as well as by monitoring therapies with potential toxic renal effect.

Porphyromonas gingivalis participates in pathogenesis of human abdominal aortic aneurysm by neutrophil activation. Proof of concept in rats.

Background: Abdominal Aortic Aneurysms (AAAs) represent a particular form of atherothrombosis where neutrophil proteolytic activity plays a major role. We postulated that neutrophil recruitment and activation participating in AAA growth may originate in part from repeated episodes of periodontal bacteremia.

Methods And Findings: Our results show that neutrophil activation in human AAA was associated with Neutrophil Extracellular Trap (NET) formation in the IntraLuminal Thrombus, leading to the release of cell-free DNA.

Mortality threshold for juvenile Chinook salmon Oncorhynchus tshawytscha in an epidemiological model of Ceratomyxa shasta.

The myxozoan parasite Ceratomyxa shasta is a significant pathogen of juvenile Chinook salmon Oncorhynchus tshawytscha in the Klamath River, California, USA. This parasite requires 2 hosts to complete its life cycle: a freshwater polychaete (Manayunkia speciosa) and a salmonid. The complex life cycle and large geographic area where infection occurs make it difficult to monitor and manage ceratomyxosis.

Association study of gene polymorphisms involved in vascular alterations in elderly hypertensives with subjective memory complaints.

Background: We have recently shown that vascular abnormalities are associated with cognitive impairment as well as with white matter hyperintensities (WMH) in elderly hypertensive patients presenting with subjective memory complaints (SMC), a population at high risk of developing dementia. The aim of the present study was to identify genetic variants associated with the degree of cognitive impairment and the severity of WMH in the same study population, focusing on genes involved in vascular alterations.

Methods: 50 gene polymorphisms known to be associated with vascular alterations (blood pressure regulation, lipid and homocysteine metabolism, thrombosis and inflammation) were genotyped using a multilocus genotyping assay in 369 elderly treated hypertensive patients >60 years of age and presenting with SMC but no dementia.

Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints.

Background: Hypertension is strongly associated with cognitive decline and a promising target for dementia prevention. Our aim was to investigate the association between different antihypertensive treatments and cognitive performance in elderly hypertensive patients presenting with subjective memory complaints.

Patients And Methods: Three hundred and seventy-eight elderly hypertensive patients more than 60 years (mean age 70.

Salivary aldosterone as a diagnostic aid in primary aldosteronism.

Recent evidence demonstrates an increased incidence of primary aldosteronism (PA) in approximately 10% of the hypertensive population, making noninvasive and simple screening methods necessary. The aim of the present study was to apply a time-resolved fluorescence immunoassay for the measurement of aldosterone in saliva and the establishment of a cut-off to identify patients with a high likelihood for PA requiring subsequent screening with the aldosterone to renin ratio. Saliva was collected (AM and PM) to ascertain an optimum time with best discriminating power between healthy and disease states.

Vascular effects of cardiotrophin-1: a role in hypertension?

Aims: To investigate cardiotrophin-1 (CT-1) effects and regulation in vascular smooth muscle cells (VSMCs) in vitro and in aortic tunica media ex vivo in normotensive Wistar rats and spontaneously hypertensive rats (SHRs).

Methods And Results: CT-1 expression was quantified by real-time reverse-transcription PCR and western blotting. CT-1-activated intracellular pathways were assessed by western bloting analysis.

AtTRB1, a telomeric DNA-binding protein from Arabidopsis, is concentrated in the nucleolus and shows highly dynamic association with chromatin.

AtTRB1, 2 and 3 are members of the SMH (single Myb histone) protein family, which comprises double-stranded DNA-binding proteins that are specific to higher plants. They are structurally conserved, containing a Myb domain at the N-terminus, a central H1/H5-like domain and a C-terminally located coiled-coil domain. AtTRB1, 2 and 3 interact through their Myb domain specifically with telomeric double-stranded DNA in vitro, while the central H1/H5-like domain interacts non-specifically with DNA sequences and mediates protein-protein interactions.

Hemorphin 7 reflects hemoglobin proteolysis in abdominal aortic aneurysm.

Objective: In human abdominal aortic aneurysm, the accumulation of blood-derived cells and proteases within the mural thrombus plays a pivotal role in the evolution toward vessel wall rupture. We sought to identify peptides released from abdominal aortic aneurysm specimens, characterized by an intraluminal thrombus.

Methods And Results: Intraluminal thrombus samples were analyzed by differential proteomics, using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry.

Effects of starting strategy on 5-min cycling time-trial performance.

The importance of pacing for middle-distance performance is well recognized, yet previous research has produced equivocal results. Twenty-six trained male cyclists (VO2 peak 62.8 +/- 5.

Spontaneous renal artery dissection: long-term outcomes after endovascular stent placement.

Purpose: To report long-term clinical and morphologic results after stent placement for spontaneous renal artery dissection (SRAD).

Materials And Methods: Between 1991 and 2006, 16 consecutive patients (13 men; mean age, 42 y +/- 12) presented with SRAD in 17 arteries. All patients had uncontrolled hypertension at the time of presentation.

[Convulsions following dialysis sessions].

A bipolar patient with renal angiosclerosis due to lithium intoxication showed convulsive crises for about four months after each haemodialysis session. Aetiological work up was not able to isolate a unique cause, but modifications in treatment relieved the symptoms.

Pulse wave velocity assessment by external noninvasive devices and phase-contrast magnetic resonance imaging in the obese.

Carotid-femoral pulse wave velocity (PWV) is considered the gold-standard measurement of arterial stiffness. Obesity, however, can render inaccurate the measurement of PWV by external noninvasive devices. Phase-contrast MRI allows the determination of aortic PWV in multiple aortic locations with intra-arterial distance measurements, as well as the assessment of aortic mechanical properties.

Saliva as a medium for aldosterone measurement in repeated sampling studies.

Background: Saliva is a readily available biological fluid, making it convenient in diagnosis of diseases and in multi-sampling protocols. Several salivary steroids give a useful index of free plasma levels. Increased incidence of primary aldosteronism (PA) in approximately 10% of the hypertensive population has increased interest in the mineralocorticoid aldosterone.

HDL antielastase activity prevents smooth muscle cell anoikis, a potential new antiatherogenic property.

Various studies using proteomic approaches have shown that HDL can carry many proteins other than its constitutive apolipoprotein A-I (apoA-I). Using mass spectrometry and Western blotting, we showed the presence of alpha(1)-antitrypsin (AAT) (SERPINA1, serpin peptidase inhibitor, clade A, an elastase inhibitor) in HDL, isolated either by ultracentrifugation or by selected-affinity immunosorption using an anti-apoA-I column. Furthermore, we report that HDL possesses potent antielastase activity.

Extracellular matrix fibrotic markers in heart failure.

Given the importance of fibrous tissue in leading to myocardial dysfunction, non-invasive assessment of fibrosis could prove a clinically useful tool in heart failure (HF) patients. Biomarkers may be used for early detection of otherwise subclinical disease, diagnostic assessment of an acute or chronic clinical syndrome, risk stratification of patients with a suspected or confirmed diagnosis, selection of an appropriate therapeutic intervention and monitoring the response to therapy. Extracellular matrix (ECM) biomarkers in HF are promising biomarkers.

Extracellular cardiac matrix biomarkers in patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure: insights from the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) study.

Background: Aldosterone stimulates cardiac collagen synthesis. Circulating biomarkers of collagen turnover provide a useful tool for the assessment of cardiac remodeling in patients with congestive heart failure and left ventricular systolic dysfunction after acute myocardial infarction.

Methods And Results: In a substudy of the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS), which evaluated the effects of the selective aldosterone receptor antagonist eplerenone versus placebo, serum levels of collagen biomarkers were measured in 476 patients with congestive heart failure after acute myocardial infarction complicated with left ventricular systolic dysfunction.

Vascular structure and function is correlated to cognitive performance and white matter hyperintensities in older hypertensive patients with subjective memory complaints.

Background And Purpose: Arterial stiffening and thickening and endothelial dysfunction may be associated with cognitive decline or white matter hyperintensities (WMH) independently of blood pressure level. We aimed to investigate, using an integrative approach, the relative contributions of structural and functional vascular factors to the degree of cognitive impairment (primary outcome) and the severity of WMH (secondary outcome) in elderly hypertensive patients with subjective memory complaints, a group prone to dementia.

Methods: A prospective, dedicated, cross-sectional population of 198 elderly hypertensive patients (mean age 69.

Mediators of neutrophil recruitment in human abdominal aortic aneurysms.

Aims: Neutrophils/platelet interactions are involved in abdominal aortic aneurysm (AAA). The intraluminal thrombus (ILT) is a human model of platelet/neutrophil interactions. The present study focused on mediators involved in neutrophil recruitment in AAA.

A multifactorial strategy of pain management is associated with less pain in scheduled vaccination of children. A study realized by family practitioners in 239 children aged 4-12 years old.

Background And Aims: The multiplicity of vaccine injections during childhood leads to iterative painful and stressful experiences which may lead in turn to anticipated pain and then possibly to a true needle phobia. We aimed at evaluating a multifactorial strategy of pain management combining pharmacological and non-pharmacological approaches during vaccination, as compared to usual care, in 4- to 12-year-old children.

Methods: In all, 239 children were enrolled by 25 family practitioners in an open-label study.

The control of vector-borne disease epidemics.

The theoretical underpinning of our struggle with vector-borne disease, and still our strongest tool, remains the basic reproduction number, R(0), the measure of long term endemicity. Despite its widespread application, R(0) does not address the dynamics of epidemics in a model that has an endemic equilibrium. We use the concept of reactivity to derive a threshold index for epidemicity, E(0), which gives the maximum number of new infections produced by an infective individual at a disease free equilibrium.

Maintenance of a computerized medical record form.

Structured entry forms for clinical records should be updated to take into account the physicians' needs during consultation and advances in medical knowledge and practice. We updated the computerized medical record form of a hypertension clinic, based on its previous use and clinical guidelines. A statistical analysis of previously completed forms identified several unnecessary items rarely used by clinicians.

Extracellular matrix turnover and inflammatory markers independently predict functional status and outcome in chronic heart failure.

Background: Inflammatory pathways may promote extracellular matrix (ECM) remodeling and chronic heart failure (CHF) progression. The relationship between markers of inflammation and of ECM remodeling, and their influence on functional status and outcomes has not been examined in a large cohort of CHF patients.

Methods And Results: We measured baseline blood serum collagen (amino-terminal propeptide of collagen III [PIIINP], metalloproteinase 1 [MMP-1], tissue inhibitor of metalloproteinase 1 [TIMP-1]), and inflammatory (high-sensitivity C-reactive protein [(hsCRP], interleukin [IL]-18, IL-10) markers in 1009 patients enrolled in the Research into Etanercept Cytokine Antagonism in Ventricular Dysfunction (RECOVER) trial.

Selection of patients for surgery for primary aldosteronism.

1. Primary aldosteronism is a condition characterized by renin suppression and various degrees of hypertension and hypokalemia caused by aldosterone hypersecretion. 2.