Predictive factors for long-term mortality in miscellaneous cardiogenic shock: Protective role of beta-blockers at admission

Abstract Background Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status. Methods To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years. Results During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247). Conclusion Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status. Funding Acknowledgement Type of funding source: None

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Abstract 129: Effects of Pulse Pressure and Antihypertensive Therapy on Short and Long Term Outcomes in Stroke Patients

Hypertension ◽

10.1161/hyp.60.suppl_1.a129 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Avinash Murthy ◽

Jaspreet Arora ◽

Amar Shah ◽

Hussain Khawaja ◽

Mikhail Torosoff

Keyword(s):

Beta Blocker ◽

Pulse Pressure ◽

Beta Blockers ◽

Long Term Outcomes ◽

Blocker Therapy ◽

Hospital Deaths ◽

Long Term Survivors ◽

Hypertensive Therapy ◽

Long Term Mortality

Background: Effects of pulse pressure and benefits of blood pressure lowering with intravenous anti-hypertensive medications and beta-blockers in CVA patients have not been well investigated. Material and Methods: Demographic, clinical, and echocardiographic data were collected and long-term outcomes (55+/-21 months) were ascertained in 356 consecutive cerebro-vascular accident (CVA) patients. ANOVA, chi-square, Kaplan-Meier, and logistic regression tests were employed. Study was approved by the institutional IRB. Results: Widened pulse pressure on admission was significantly elevated in CVA patients who expired in the hospital or during the long-term follow-up (62+/-21mmHg for long-term survivors vs. 72+/-20mmHg for hospital deaths vs. 69+/-28 mmHg for long-term deaths, p=0.01). There was a trend towards increased hospital mortality (14% in long-term survivors vs. 25% in hospital deaths vs. 22% in long-term deaths, p=0.110) in CVA patients requiring IV anti-hypertensive therapy. Utilization of beta-blockers was lower in patients who suffered hospital death, but more likely in patients experiencing long-term death (42% use in hospital deaths vs. 48% in long-term survivors vs. vs. 66% in long-term deaths, p=0.003). Beta-blocker use was not predictive of hospital outcomes but was strongly predictive of adverse event long-term events (HR 2.1, 95%CI 1.3-3.4, p=0.002). When adjusted for demographic parameters and co-morbidities in multivariate analysis, pulse pressure and IV anti-hypertensive therapy were not predictive of short or long-term outcomes, while beta-blocker treatment was associated with reduced hospital (0.3, 95%CI 0.1-0.9, p=0.029) but not long-term mortality. Conclusions: Widened pulse pressure and need for IV anti-hypertensive therapy are not predictive of adverse short- or long-term outcomes when demographics and co-morbidities are accounted for. Effects of beta-blocker therapy on outcomes in CVA patients are complex. Wider beta-blocker use in acute CVA may be associated with better hospital outcomes, while increased long term mortality with beta-blocker therapy may be indicative of poor cardiovascular health leading to adverse outcomes

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Keratoprostheses in silicone oil-filled eyes: long-term outcomes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312426 ◽

2018 ◽

Vol 103 (6) ◽

pp. 781-788 ◽

Cited By ~ 2

Author(s):

Geetha Iyer ◽

Bhaskar Srinivasan ◽

Shweta Agarwal ◽

Ruchika Pattanaik ◽

Ekta Rishi ◽

...

Keyword(s):

Silicone Oil ◽

Vitreoretinal Surgery ◽

Retrospective Chart Review ◽

Protective Role ◽

Visual Rehabilitation ◽

Two Factors

PurposeTo analyse the functional and anatomical outcomes of different types of keratoprostheses in eyes with retained silicone oil following vitreoretinal surgery.MethodsRetrospective chart review of patients operated with any type of permanent keratoprosthesis (Kpro) in silicone oil-filled eyes between March 2003 and June 2017 were analysed.Results40 silicone oil-filled eyes underwent keratoprostheses, of which 22 were type 1 and 18 were type 2 Kpros (Lucia variant—nine, modified osteo odonto kerato prosthesis (MOOKP)—four, Boston type 2—three and osteoKpro—two) with a mean follow-up of 61.54 , 42.77, 45.25 , 25 and 37 months, respectively. Anatomic retention of the primary Kpro was noted in 33 eyes (82.5%). A best-corrected visual acuity of better than 20/200 and 20/400 was achieved in 26 (65%)+32 (80%) eyes. Retroprosthetic membrane (RPM) was the most common complication noted in 17 eyes (42.5%). Perioptic graft melt was noted in 4 of 22 eyes of the type 1 Kpro (2 (10.5%) without associated ocular surface disorder (OSD)) and in 1 eye each of Boston and Lucia type 2 Kpro. Laminar resorption occurred in one eye each of the MOOKP and OKP groups. Endophthalmitis and glaucoma did not occur in any eye.ConclusionAppropriately chosen keratoprosthesis is a viable option for visual rehabilitation in eyes post vitreoretinal surgery with retained silicone oil-induced keratopathy not amenable to conventional penetrating keratoplasty. Kpro melt among type 1 Kpro did not occur in 89.5% eyes without associated OSD (19 of 22 eyes), despite the lack of aqueous humour and presence of RPM (4 eyes), two factors considered to play a significant role in the causation of sterile melts. Of interest to note was the absence of infection in any of these eyes. The possible protective role of oil from endophthalmitis is interesting, though yet to be ascertained.

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Mending Broken Hearts

Journal of Health and Social Behavior ◽

10.1177/0022146511432342 ◽

2012 ◽

Vol 53 (1) ◽

pp. 33-49 ◽

Cited By ~ 31

Author(s):

Ellen L. Idler ◽

David A. Boulifard ◽

Richard J. Contrada

Keyword(s):

Medical Records ◽

Lower Risk ◽

Adult Mortality ◽

Men And Women ◽

Never Married ◽

The Social ◽

Using Data ◽

Long Term Mortality

Marriage has long been linked to lower risk for adult mortality in population and clinical studies. In a regional sample of patients ( n = 569) undergoing cardiac surgery, we compared 5-year hazards of mortality for married persons with those of widowed, separated or divorced, and never married persons using data from medical records and psychosocial interviews. After adjusting for demographics and pre- and postsurgical health, unmarried persons had 1.90 times the hazard of mortality of married persons; the disaggregated widowed, never married, and divorced or separated groups had similar hazards, as did men and women. The adjusted hazard for immediate postsurgical mortality was 3.33; the adjusted hazard for long-term mortality was 1.71, and this was mediated by married persons’ lower smoking rates. The findings underscore the role of spouses (both male and female) in caregiving during health crises and the social control of health behaviors.

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Glutathione Protects Lactobacillus sanfranciscensis against Freeze-Thawing, Freeze-Drying, and Cold Treatment

Applied and Environmental Microbiology ◽

10.1128/aem.00026-09 ◽

2010 ◽

Vol 76 (9) ◽

pp. 2989-2996 ◽

Cited By ~ 37

Author(s):

Juan Zhang ◽

Guo-Cheng Du ◽

Yanping Zhang ◽

Xian-Yan Liao ◽

Miao Wang ◽

...

Keyword(s):

Fatty Acids ◽

Stress Responses ◽

Freeze Drying ◽

Unsaturated Fatty Acids ◽

Cold Treatment ◽

Protective Role ◽

Intracellular Accumulation ◽

Lactobacillus Sanfranciscensis

ABSTRACT Lactobacillus sanfranciscensis DSM20451 cells containing glutathione (GSH) displayed significantly higher resistance against cold stress induced by freeze-drying, freeze-thawing, and 4°C cold treatment than those without GSH. Cells containing GSH were capable of maintaining their membrane structure intact when exposed to freeze-thawing. In addition, cells containing GSH showed a higher proportion of unsaturated fatty acids in cell membranes upon long-term cold treatment. Subsequent studies revealed that the protective role of GSH against cryodamage of the cell membrane is partly due to preventing peroxidation of membrane fatty acids and protecting Na+,K+-ATPase. Intracellular accumulation of GSH enhanced the survival and the biotechnological performance of L. sanfranciscensis, suggesting that the robustness of starters for sourdough fermentation can be improved by selecting GSH-accumulating strains. Moreover, the results of this study may represent a further example of mechanisms for stress responses in lactic acid bacteria.

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Inner child of the past: long-term protective role of childhood relationships with mothers and fathers and maternal support for mental health in middle and late adulthood

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-021-02200-y ◽

2021 ◽

Author(s):

Ping Chen

Keyword(s):

Mental Health ◽

Protective Role ◽

Maternal Support ◽

Late Adulthood ◽

Mothers And Fathers ◽

The Past ◽

Inner Child ◽

Childhood Relationships

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Long-term mortality comparison of patients with acute myocardial infarction complicated by cardiogenic shock and treated with culprit-only or multivessel percutaneous coronary intervention

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2020.06.021 ◽

2020 ◽

Author(s):

Ruben Vergara ◽

Elisa Vignini ◽

Michele Ciabatti ◽

Angela Migliorini ◽

Renato Valenti ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Cardiogenic Shock ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Long Term Mortality

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The protective role of alpha-lipoic acid on long-term exposure of rats to the combination of chlorpyrifos and deltamethrin pesticides

Toxicology and Industrial Health ◽

10.1177/0748233715616553 ◽

2016 ◽

Vol 33 (2) ◽

pp. 159-170 ◽

Cited By ~ 9

Author(s):

Chidiebere Uchendu ◽

Suleiman F Ambali ◽

Joseph O Ayo ◽

King AN Esievo

Keyword(s):

Lipoic Acid ◽

Lethal Dose ◽

Liver Homogenate ◽

Experimental Period ◽

Protective Role ◽

Serum Glucose ◽

Group I ◽

Male Wistar Rats

The study was aimed at evaluating the protective role of α-lipoic acid (ALA) on long-term exposure of rats to the combination of chlorpyrifos (CPF) and deltamethrin (DLT). Forty-two (42) male Wistar rats were divided into 6 exposure groups with 7 animals in each group: (I) soya oil (2 ml kg−1), (II) ALA (60 mg kg−1), (III) DLT (6.25 mg kg−1), (IV) CPF (4.75 mg kg−1), (V) (CPF + DLT) DLT (6.25 mg kg−1) and CPF (4.75 mg kg−1; 1/20th of the previously determined median lethal dose) and (VI) (ALA + CPF + DLT) pretreated with ALA (60 mg kg−1) and then co-exposed to CPF and DLT, 45 min later. The regimens were administered by gavage once daily for a period of 16 weeks. Sera obtained from blood collected at the end of the experimental period were used for the evaluation of serum glucose, total protein, albumin, urea, creatinine and the activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase and acetylcholinesterase. The liver homogenate was used to assay for the activities of superoxide dismutase and glutathione peroxidase and the concentrations of malondialdehyde, cytokine and tumour necrotic factor α. The result showed that the combination of CPF and DLT resulted in marked alterations of these biochemical parameters in most cases compared to either of the pesticides singly, supplementation with ALA ameliorated these alterations.

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