Tricuspid regurgitation in elderly patients with acute heart failure: insights from the KCHF registry

AIMS: Several studies demonstrated that tricuspid regurgitation (TR) is associated with poor clinical outcomes. However, data on patients with TR who experienced acute heart failure (AHF) remains scarce. The purpose of this study is to evaluate the association between TR and clinical outcomes in patients admitted with AHF, using a large-scale Japanese AHF registry. METHODS AND RESULTS: The current study population consisted of 3735 hospitalized patients due to AHF in the Kyoto Congestive Heart Failure (KCHF) registry. TR grades were assessed according to the routine clinical practice at each participating centre. We compared the baseline characteristics and outcomes according to the severity of TR. The primary outcome was all-cause death. The secondary outcome was hospitalization for heart failure (HF). The median age of the entire study population was 80 (interquartile range: 72-86) years. One thousand two hundred five patients (32.3%) had no TR, while mild, moderate, and severe TR was found in 1537 patients (41.2%), 776 patients (20.8%), and 217 patients (5.8%), respectively. Pulmonary hypertension, significant mitral regurgitation, and atrial fibrillation/flutter were strongly associated with the development of moderate/severe of TR, while left ventricular ejection fraction <50% was inversely associated with it. Among 993 patients with moderate/severe TR, the number of patients who underwent surgical intervention for TR within 1 year was only 13 (1.3%). The median follow-up duration was 475 (interquartile range: 365-653) days with 94.0% follow-up at 1 year. As the TR severity increased, the cumulative 1 year incidence of all-cause death and HF admission proportionally increased ([14.8%, 20.3%, 23.4%, 27.0%] and [18.9%, 23.0%, 28.5%, 28.4%] in no, mild, moderate, and severe TR, respectively). Compared with no TR, the adjusted risks of patients with mild, moderate, and severe TR were significant for all-cause death (hazard ratio [95% confidence interval]: 1.20 [1.00-1.43], P = 0.0498, 1.32 [1.07-1.62], P = 0.009, and 1.35 [1.00-1.83], P = 0.049, respectively), while those were not significant for hospitalization for HF (hazard ratio [95% confidence interval]: 1.16 [0.97-1.38], P = 0.10, 1.19 [0.96-1.46], P = 0.11, and 1.20 [0.87-1.65], P = 0.27, respectively). The higher adjusted HRs of all the TR grades relative to no TR were significant for all-cause death in patients aged <80 years, but not in patients aged ≥80 years with significant interaction. CONCLUSIONS: In a large Japanese AHF population, the grades of TR could successfully stratify the risk of all-cause death. However, the association of TR with mortality was only modest and attenuated in patients aged 80 or more. Further research is warranted to evaluate how to follow up and manage TR in this elderly population

Salt Dependence of the Chain Stiffness and Excluded-Volume Strength for the Polymethacrylate-Type Sulfopropylbetaine in Aqueous NaCl Solutions

A series of zwitterionic polyelectrolytes poly­[3-(<i>N</i>-2-methacryl­oyloxy­ethyl-<i>N</i>,<i>N</i>-dimethyl)­ammonato­propane­sulfonate] (PMAPS) with a wide range of weight-average molecular weight (<i>M</i>_w) between 5.5 × 10³ and 1.6 × 10⁶ g mol^–1 with narrow molecular weight distribution (<i>M</i>_w/<i>M</i>_n = 1.07–1.19) were thoroughly characterized in aqueous NaCl solutions for salt concentration (<i>C</i>_s) over a range from theta <i>C</i>_s (0.074 M) to 1.0 M by synchrotron radiation small-angle X-ray scattering (SAXS), light scattering, and viscometry at 25 °C. To determine the chain stiffness parameter (λ^–1) and the excluded-volume strength (<i>B</i>) of PMAPS in an aqueous NaCl solution, SAXS profiles and the <i>M</i>_w dependences of the radius of gyration, the second virial coefficient, the interpenetration function, the hydrodynamic radius, and the intrinsic viscosity for PMAPS were analyzed on the basis of the (un)­perturbed cylindrical wormlike chain model. The experimental λ^–1 value for PMAPS chains in aqueous NaCl solutions barely decreased but was almost constant with the increasing <i>C</i>_s, whereas the value of <i>B</i> was increased gradually with the increasing <i>C</i>_s. Thus, the dominant factor for the chain dimension of PMAPS in aqueous NaCl solutions was the long-range interaction (i.e., <i>B</i>) than the short-range interaction (i.e., λ^–1). The observed <i>C</i>_s dependences of λ^–1 and <i>B</i> for PMAPS chains in aqueous NaCl solutions were fairly described by the theories of the polyampholyte with the nonrepulsive, the repulsive, and the attractive electrostatic interactions

OVOL1はヒト皮膚の内毛根鞘，脂腺，汗腺とその腫瘍に発現している

OVOL1 is an important transcription factor for epidermal keratinization, which suppresses proliferation and switches on the differentiation of keratinocytes. A recent genome-wide association study has revealed that OVOL1 is one of the genes associated with susceptibility to atopic dermatitis. Although it is known to be expressed in murine skin and hair follicles, no investigations have focused on its localization in human skin. In the present study, we thus immunolocalized the expression of OVOL1 in normal and diseased human skin. In normal human skin, OVOL1 was preferentially expressed in the suprabasal layer of the epidermis, inner root sheath of hair, mature sebocytes and the ductal portion of the eccrine glands. Compared to this, no remarkable change in the expression of OVOL1 was observed among inflammatory skin diseases. The expression of OVOL1 was evident in eccrine poroma and hidradenoma. Moreover, it was overexpressed in Bowen\u27s disease and sebaceous adenoma, in sharp contrast to its downregulation in their more malignant counterparts, squamous cell carcinoma and sebaceous carcinoma. OVOL1 may play an important role in human skin morphogenesis and tumorigenesis.OVOL1は表皮細胞の増殖を抑制し角化を推進させる転写因子と考えられている．最近のgenome-wide association studyでは，アトピー性皮膚炎の疾患感受性遺伝子の一つとしても注目を浴びている．マウスではOvol1は皮膚及び毛囊に発現していることが報告されているがヒトでの研究はこれまで報告されていない．本研究では，ヒト健常皮膚および皮膚疾患で, OVOL1の発現を免疫組織学的に明らかにした．健常皮膚では，OVOL1は基底層上層の表皮細胞，毛囊の内毛根鞘，成熟した脂腺細胞，エクリン汗腺の導管部に優位に発現していた．炎症性皮膚疾患のOVOL1の発現は健常皮膚に比べ変化を認めなかった．OVOL1の発現はeccrine poromaとhidradenomaで亢進していた．ボーエン病と脂腺腫ではOVOL1の発現は亢進していたが，有棘細胞癌や脂腺癌ではむしろ減少していた．OVOL1はヒト皮膚の器官形成や腫瘍発生に重要な役割をになっているのではないかと考えた