BACKGROUND: Patients aged 85 years or older admitted for heart failure (HF) have increased enormously due to improved survival in this disease. However, few studies assess the characteristics, treatments, and prognosis of very elderly patients admitted for acute HF. METHODS: This study is a retrospective analysis of the EPICTER registry, that included patients admitted for acute HF in 74 Spanish hospitals. For this analysis, a total of 1887 patients were included and divided into 2 groups: 85 years or older (very elderly, 680 patients) and those under 85 years. RESULTS: Compared to patients < 85 years, very elderly patients were more frequently women, had more hypertension and disease cerebrovascular disease, and less presence of chronic obstructive pulmonary disease (COPD), diabetes, and acute myocardial infarction. There were no differences in symptoms, except for delirium, significantly more common in very elderly patients. Management of these patients was more conservative and died more than the younger ones (41% vs. 25%, P < 0.001). The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease, delirium, and estimated survival of less than 6 months assessed by the physician in charge of the patient care. CONCLUSION Very elderly patients admitted for HF differ from younger ones in comorbidities, management, and symptoms, and have higher mortality. The presence of delirium, peripheral arterial disease, and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.

Background: Gait speed is associated with a higher prevalence of balance disorders in older adults residing at high altitudes. This study investigated this association in older adults from 12 high-altitude Andean Peruvian communities. Methods: We performed a secondary data analysis from an analytical cross-sectional study of adults >60 years of age, residing in 12 high-altitude Andean Peruvian communities, enrolled between 2013 and 2019. The exposure and outcome variables were gait speed (categorized in tertiles), and balance disorders (defined as a functional reach value of ≤20.32 cm), respectively. We built generalized linear models of the Poisson family with a logarithmic link function and robust variances, and estimated crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with 95% confidence intervals (CIs). Results: We analyzed 418 older adults; 38.8% (n=162) were male, and the mean age was 73.2±6.9 years. The mean gait speed and functional reach were 0.66±0.24 m/s and 19.9±6.48 cm, respectively. In the adjusted regression model, the intermediate (aPR=1.88; 95% CI, 1.39–2.55; p<0.001) and low (aPR=2.04; 95% CI, 1.51–2.76; p<0.001) tertiles of gait speed were associated with a higher prevalence of balance disorders. Conclusion The intermediate and low tertiles of gait speed were associated with a higher prevalence of balance disorders among older adult residents of 12 high-altitude Andean communities. We recommend further research on the behavior of this association to propose interventions for these vulnerable groups and reduce the impact of geriatric conditions.

Purpose: To relate the prostate volume category (PVC) assessed with digital rectal examination (DRE)—small, median, and large—and the prostate volumes (PVs) assessed with magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS). To compare the clinically significant prostate cancer (csPCa) discrimination ability of two predictive models based on DRE-PVC and MRI-PV. Materials and Methods: A prospective trial of 2,090 men with prostate-specific antigen >3 ng/mL and/or PCa suspicious DRE were prospectively recruited in 10 centers from Catalonia (Spain), between 2021 and 2022, in whom DRE-PVC was assessed. Pre-biopsy MRI, and 12-core TRUS-random biopsy was always performed after 2- to 6-core TRUS-fusion targeted biopsy of prostate imaging-report and data system >3 lesions. In 370 men (17.7%) the DRE-PVC was unconclusive. Among the 1,720 men finally analyzed the csPCa (grade group >2) detection was 42.4%. Results: The median (interquartile range) of TRUS and MRI-PVs of small prostates were 33 mL (19–37 mL) and 35 mL (23–30 mL), p=0.410; in median prostates they were 51 mL (38–58 mL) and 55 mL (48–63 mL) respectively, p<0.001; in large prostates 80 mL (60–100 mL) and 95 mL (75–118 mL) respectively, p<0.001. The predictive models sharing the MRI-PV and DRE-PVC showed areas under the curves of 0.832 (95% confidence interval [CI], 0.813–0.851) and 0.828 (95% CI, 0.809–0.848) respectively, p=0.632, as well as similar net benefit and clinical utility. Conclusions PVC was unconclusive in 17% of DREs. MRI-PV overestimated the TRUS-PV in median and large prostates. The predictive models based on MRI-PV and DRE-PVC showed similar efficacy to predict csPCa. PVC assessed with DRE is helpful to predict the csPCa risk before MRI.

Background/Aims: The evidence suggests that a shorter esophageal length (EL) in gastroesophageal reflux disease (GERD) patients is associated with the presence of hiatal hernia (HH). However, there are no reports of this association in patients with achalasia. The aim is to (1) determine the prevalence of hiatal hernia in achalasia patients, (2) compare achalasia EL with GERD patients and healthy volunteers (HV), (3) measure achalasia manometric esophageal length to height (MELH) ratio, and (4) determine if there are differences in symptoms between patients with and without hiatal hernia. Methods: This retrospective and cross-sectional study consist of 87 pre-surgical achalasia patients, 22 GERD patients, and 30 HV. High-resolution manometry (HRM), barium swallow, and upper endoscopy were performed to diagnose HH. The EL and MELH ratio were measured by HRM. Symptoms were assessed with Eckardt, Eating Assessment Tool, and GERD–health-related quality of life questionnaires. Results: The HH in GERD’s prevalence was 73% vs 3% in achalasia patients (P < 0.001). Achalasia patients had a longer esophagus and a higher MELH ratio than HV and GERD patients (P < 0.001). GERD patients had a lower MELH ratio than HV (P < 0.05). EAT-10 (P < 0.0001) and Eckardt (P < 0.05) scores were higher in achalasia without HH vs HH. Conclusions The prevalence of HH in achalasia is significantly lower than in GERD. The longer EL and the higher MELH ratio in achalasia could explain the lower prevalence of HH. Despite the low prevalence of HH in achalasia patients, the surgeon should be encouraged not to rule out HH since the risk of postoperative reflux may increase if this condition is not identified and corrected.

Acute kidney injury (AKI) is characterized by tubular cell death and interstitial inflammation. TWEAK promotes experimental kidney injury and activates the transcription factor NF-κB, a key regulator of genes involved in cell survival and inflammatory response. In search of potential therapeutic targets for AKI, we compared a transcriptomics database of NF-κB-related genes from murine AKI-kidneys with a transcriptomics database of TWEAK-stimulated cultured tubular cells. Four out of twenty-four (17%) genes were significantly upregulated (false discovery rate, FDR<0.05), while nine out of twenty-four (37%) genes were significantly upregulated at FDR <0.1 in both databases. Bcl3 was the top upregulated NF-κB-related gene in experimental AKI and one of the most upregulated genes in TWEAK-stimulated tubular cells. Quantitative reverse transcription PCR (qRT-PCR), western blot and immunohistochemistry confirmed Bcl3 upregulation in both experimental conditions and localized increased Bcl3 expression to tubular cells in AKI. Transcriptomics database analysis revealed increased Bcl3 expression in numerous experimental and human kidney conditions. Furthermore, systemic TWEAK administration increased kidney Bcl3 expression. In cultured tubular cells, targeting Bcl3 by siRNA resulted in the magnification of TWEAK-induced NF-κB transcriptional activity, chemokine upregulation and Klotho downregulation, and in the sensitization to cell death induced by TWEAK/TNFα/interferon-γ. In contrast, Bcl3 overexpression decreased NF-κB transcriptional activity, inflammatory response and cell death while dampening the decrease in Klotho expression. In conclusion, Bcl3 expressed in response to TWEAK stimulation decreases TWEAK-induced inflammatory and lethal responses. Therefore, therapeutic upregulation of Bcl3 activity should be explored in kidney disease because it has advantages over chemical inhibitors of NF-κB that are known to prevent inflammatory responses but can also sensitize the cells to apoptosis.
Acute Kidney Injury* ; Apoptosis ; Blotting, Western ; Cell Death ; Cell Survival ; Down-Regulation ; Humans ; Immunohistochemistry ; Inflammation ; Kidney ; Kidney Diseases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Small Interfering ; Transcription Factors ; Up-Regulation

Objective To evaluate differences in yield and composition of the essential oil and antioxidant contents in Turnera diffusa plants from localities in central region of Tamaulipas. Methods Samples were collected in Tamaulipas, Mexico in the arid zone. Essential oil was obtained through steam distillation and analyzed using GC–MS. Polyphenol contents, antioxidant activities using ABTS and ferric reducing antioxidant power (FRAP) methods also were evaluated. Results A total of 21 compounds were identified in the essential oils; nevertheless, only Eucalyptol, 1,4-Methanocycloocta[d]pyridazine, 1,4,4a,5,6,9,10,10a-octahydro-11,11-dimethyl-, (1à,4à,4aà,10aà) y Ethanone, 1-(1,3-dimethyl-3-cyclohexen-1-yl) were detected in the three sites. Highest contents were registered in the sample from Padrón y Juárez with phenolic content of 33.85 mg GAE/g of dry material and antioxidant activities with ABTS 72.32% and with FRAP 21.33 mg GAE/g of dry material. Statistical differences were observed in essential oil, phenolics and antioxidants contents between populations. Conclusions Results suggest that climatic differences and origin influence the phytochemicals in the medicinal plant Turnera diffusa, and thus, it is worth to consider such effects for industrial and medicinal purposes.

Objective To explore the anti-proliferative activity of purified L-asparaginase from Aspergillus oryzae CCT 3940 (A. oryzae). Methods L-asparaginase was produced by submerged fermentation and purified to electrophoresis homogeneity by ionic exchanged chromatography in a fast protein liquid chromatographic system. The purified enzyme was characterized and used for the antiproliferative assay against nine tumor cell lines and one non-tumor cell line. Results The free glutaminase L-asparaginase was purified 28.6 fold. L-asparaginase showed high stability under physiological condition, remaining stable in the pH range 7.0–8.0 after 1 h incubation at temperature range 30–45 °C. The Km and Vmax values of purified L-asparaginase were estimated as 0.66 mmol/L and 313 IU/mL, respectively. The purified enzyme could inhibit the growth of a broad range of human tumor cell lines at the concentrations studied. Also, the enzyme from A. oryzae CCT 3940 could inhibit tumor growth of leukemia cell line (K562) with a total growth inhibition value of (3.2 ± 2.5) IU/mL and did not inhibit the non-carcinogenic human cell line growth at the concentrations studied. Conclusions The sensitivity of the cells lines to purified L-asparaginase from A. oryzae CCT 3940 appeared to be concentration dependent affording a more significant decrease in cell growth than that observed for the commercial L-asparaginase from Escherichia coli. The L-asparaginase from A. oryzae CCT 3940 has a high potential for pharmaceutical exploitation in the treatment of leukemia.

PURPOSE: We aimed to ascertain the degree of association between bladder cancer and human papillomavirus (HPV) infection. MATERIALS AND METHODS: We performed a meta-analysis of observational studies with cases and controls with publication dates up to January 2011. The PubMed electronic database was searched by using the key words "bladder cancer and virus." Twenty-one articles were selected that met the required methodological criteria. We implemented an internal quality control system to verify the selected search method. We analyzed the pooled effect of all the studies and also analyzed the techniques used as follows: 1) studies with DNA-based techniques, among which we found studies with polymerase chain reaction (PCR)-based techniques and 2) studies with non-PCR-based techniques, and studies with non-DNA-based techniques. RESULTS: Taking into account the 21 studies that were included in the meta-analysis, we obtained a heterogeneity chi-squared value of Qexp=26.45 (p=0.383). The pooled odds ratio (OR) was 2.13 (95% confidence interval [CI], 1.54 to 2.95), which points to a significant effect between HPV and bladder cancer. Twenty studies assessed the presence of DNA. The overall effect showed a significant relationship between virus presence and bladder cancer, with a pooled OR of 2.19 (95% CI, 1.40 to 3.43). Of the other six studies, four examined the virus's capsid antigen and two detected antibodies in serum by Western blot. The estimated pooled OR in this group was 2.11 (95% CI, 1.27 to 3.51), which confirmed the relationship between the presence of virus and cancer. CONCLUSIONS: The pooled OR value showed a moderate relationship between viral infection and bladder tumors.
Antibodies ; Blotting, Western ; Capsid ; Chronology as Topic ; DNA ; Electronics ; Electrons ; Humans ; Odds Ratio ; Polymerase Chain Reaction ; Population Characteristics ; Publications ; Quality Control ; Urinary Bladder ; Urinary Bladder Neoplasms ; Viruses