BackgroundNutritional status has been related to clinical outcomes in patients with heart failure. We assessed the association between nutritional status, indexed by prognostic nutritional index (PNI), and survival in patients hospitalized for acute heart failure.Methods and ResultsA total of 1673 patients (age 76±13 years, 68% men) hospitalized for acute heart failure in a tertiary medical center were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm3). National Death Registry was linked to identify the clinical outcomes of all‐cause and cardiovascular death. With increasing tertiles of PNI, age and N‐terminal probrain natriuretic peptide decreased, and body mass index, estimated glomerular filtration rate, and hemoglobin increased. During a mean follow‐up duration of 31.5 months, a higher PNI tertile was related to better survival free from all‐cause and cardiovascular mortality in the total study population and in participants with either reduced or preserved left ventricular ejection fraction. After accounting for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, serum sodium level, and on‐admission systolic blood pressure, PNI was independently associated with cardiovascular death and total mortality (hazard ratio per 1 SD of the natural logarithm of the PNI: 0.76 [95% CI, 0.66–0.87] and 0.79 [95% CI, 0.73–0.87], respectively). In subgroup analyses stratified by age, sex, left ventricular ejection fraction, body mass index, or estimated glomerular filtration rate, PNI was consistently related to mortality.Conclusions PNI is independently associated with long‐term survival in patients hospitalized for acute heart failure with either reduced or preserved left ventricular ejection fraction.

Objectives 1) To quantify night-to-night variability in sleep behaviors and sleep measures among older chronic insomnia (CI) subjects and non-insomnia (NI) controls; 2) to investigate systematic temporal patterns of sleep behaviors and sleep measures across nights; and 3) to examine clinical correlates of sleep variability. Methods Sixty-one older adults with CI (71.4 years old, 67%F) and 31 older adults with NI (70.7 years old, 65%F) completed questionnaires and kept sleep diaries and wore wrist actigraphs for two weeks. Mixed models were used to estimate within-subject mean and standard deviation values; these were then compared across groups. Mixed models were also used to determine associations across nights of sleep measures. Results CI and NI differed on mean values for clinical ratings and sleep diary measures, but not for actigraphy measures. CI also showed significantly greater variability than NI on most sleep diary measures and on actigraphically-measured wakefulness after sleep onset (WASO) and sleep efficiency. Among CI, neither diary nor actigraphy measures from one night correlated with values from the previous night. Diary WASO and sleep time and actigraphy sleep latency and sleep time, however, positively correlated with values from the previous two nights. Variability measures were not correlated with other global clinical measures among CI. Conclusions Compared to NI, older adults with CI report worse sleep and greater night-tonight variability, which was confirmed with actigraphy. There was little evidence for positive or negative correlation of sleep measures across nights. Variability of sleep may be an important target for insomnia treatments.

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Exosomes are a subset of tiny extracellular vesicles manufactured by all cells and are present in all body fluids. They are produced actively in tumor cells, which are released and utilized to facilitate tumor growth. Their characteristics enable them to assist major cancer hallmarks, leveraged by cancer cells in fostering cancer growth and spread while implementing ways to escape elimination from the host environment. This review updates on the latest progress on the roles of cancer-derived exosomes, of 30-100 nm in size, in deregulating paracrine trafficking in the tumor microenvironment and circulation. Thus, exosomes are being exploited in diagnostic biomarker development, with its potential in clinical applications as therapeutic targets utilized in exosome-based nanoparticle drug delivery strategies for cancer therapy. Ongoing studies were retrieved from PubMed ® and Scopus database and ClinicalTrials.gov registry for review, highlighting how cancer cells from entirely different cell lines rely on genetic information carried by their exosomes for homotypic and heterotypic intercellular communications in the microenvironment to favor proliferation and invasion, while establishing a pre-metastatic niche in welcoming cancer cells' arrival. We will elaborate on the trafficking of tumor-derived exosomes in fostering cancer proliferation, invasion, and metastasis in hematopoietic (leukemia and myeloma), epithelial (breast cancer), and mesenchymal (soft tissue sarcoma and osteosarcoma) cancers. Cancer-derived exosomal trafficking is observed in several types of liquid or solid tumors, confirming their role as cancer hallmark enabler. Their enriched genetic signals arising from their characteristic DNA, RNA, microRNA, and lncRNA, along with specific gene expression profiles, protein, or lipid composition carried by the exosomal cargo shed into blood, saliva, urine, ascites, and cervicovaginal lavage, are being studied as a diagnostic, prognostic, or predictive cancer biomarker. We reveal the latest research efforts in exploiting the use of nanoparticles to improve the overall cancer diagnostic capability in the clinic.

LeBreton et al. / Photoelectron Studies of Biological Pyrimidines 2303 particles of this size. Also, it is impossible to align "B" phase samples using microscope cover slips, as for D phase samples. This also indicates the presence of many defects in the samples (Le., small crystallite size). Where it was possible to measure A values for the B phase, the values are similar to those in the D phase and do not reflect the presence of a first-order phase change. Since similar NMR behavior was observed for systems containing "B" phase (sodium octanoate, sodium octyl sulfate) and the one without a B phase (sodium octyl sulfonate) it seems likely that "B" phase is simply a continuation of D phase at high water content, and that no first-order B/D phase change exists. In the original paper,16 Ekwall et al. concluded that the x-ray evidence for the coexistence of B + D phases was not unequivocal. The boundaries shown in Figure 4 were obtained by analysis of separated samples after prolonged centrifugation. It is possible that the gravity gradient along the centrifuge tubes caused the separation observed. Certainly it is hard to find a physical reason why lamellar phase samples with -64 A water layer should separate from samples with -72 A water layers as was observed. There appears to be a case for the reexamination of low-angle x-ray scattering on samples in the B + D two-phase region.Abstract: UV photoelectron spectroscopy and C N D O j S molecular orbital calculations have been employed to investigate the electronic structure of cytosine (I), 1-methylcytosine (II), N,1-dimethylcytosine (III), N,N,l-trimethylcytosine (IV), 3-methylcytosine (V), 1,5-dimethylcytosine (VI), 1,6-dimethylcytosine (VII), 5-methylcytosine (VIII), and 6-methylcytosine (IX). The resolution of the spectra obtained for different members of this series of molecules varies markedly. Of all the molecules investigated the photoelectron bands arising from the five uppermost orbitals are well resolved only for N , I-dimethylcytosine. The variation in the resolution arises partially from the overlapping of bands. Furthermore, spectra obtained for molecules in which labile H atoms are replaced by methyl groups exhibit much better resolution than spectra for other molecules. This observation is probably related to hydrogen bonding effects. For cytosine the spacing of bands occurring in the spectrum is accurately reproduced in the results of C N D O / S calculations carried out on the 1(H) aminooxo tautomeric form of the molecule. In compounds 11-IV and VI-IX the spacing of bands and the shifts observed in the spectra are also well predicted by calculations carried out on the aminooxo tautomers. However, for 3-methylcytosine the results indicate that an imino tautomeric form is most stable. For all compounds the C N D O / S calculations indicate that three of the five uppermost orbitals are A orbitals and that two are lone-pair orbitals. In cytosine the first and fifth bands arise from A orbitals while the fourth band arises from a lone-pair orbital. The se...

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The therapeutic effect of ultrasonographically guided aspiration of a ganglion cyst of the shoulder is evaluated. Fifteen patients (nine male, six female) with chronic shoulder pain were enrolled in this study. Each patient was referred to rule out rotator cuff lesion. The ultrasonographic examination showed an anechoic cystic lesion in the shoulder region in every patient and abnormality of the rotator cuff in only four patients. Under ultrasonographic guidance, an 18 gauge needle was inserted into the cyst to aspirate the fluid. Initial sonographic imaging showed the cyst, which appeared as a localized fluid accumulation and was located between the deltoid muscle and the subscapularis tendon in seven patients, between the deltoid muscle and the biceps tendon in one patient, below the coracoacromial ligament in five patients, and over suprascapular notch area in one patient. The ganglion cysts ranged in size from 3.5 to 30 mm. The amount of aspirated fluid in each cyst varied from 0.4 to 12 ml (mean, 2.6 ml +/- 3.1) with a clear or light yellowish color and a jelly-like appearance. No major complications occurred during or after this procedure. The symptom (pain) was improved after sonographically guided aspiration in each patient. Follow-up study showed complete relief of pain in four patients, marked improvement in nine patients, and mild improvement but still persistent shoulder pain in two patients. Duration of follow-up study ranged from 2 to 24 months (mean, 6.4 months +/- 6.9). The success rate for sonographically guided aspiration was 86% on the basis of marked symptom improvement or relief. Ultrasonographically guided aspiration of shoulder ganglion cysts is an effective procedure in the management of shoulder pain caused by ganglion cysts.