Determinants of inappropriate circadian blood pressure variability in children with essential hypertension

BACKGROUND:

Inappropriate daily profile of blood pressure deteriorates the clinical outcome of hypertension and increases distant cardiovascular risk. The problem is important, especially in children and adolescents in whom early intervention helps to prevent complications of hypertension such as left ventricular hypertrophy and hypertensive retinopathy.

OBJECTIVES:

To assess circadian blood pressure profile and basic determinants of inappropriate daily blood pressure variability in hypertensive children.

METHODS:

The project was conducted retrospectively in 106 children six to 18 years of age (mean [± SD] 14.9±2.5 years) with essential hypertension and no use of antihypertensive drugs. The study group included 43 children with inappropriate daily blood pressure variability (‘nondippers’) and 63 controls with appropriate daily blood pressure variability (‘dippers’).

RESULTS:

Nondippers, compared with dippers, had higher systolic and diastolic blood pressure at night (systolic, 123.9±10.3 mmHg versus 113.9±8.2 mmHg; diastolic, 65.1±7.6 mmHg versus 59.5±6.5 mmHg; P<0.0001), and higher blood pressure load at night (systolic, 61.9% versus 27.6%; diastolic, 20.0% versus 9.6%; P<0.0001). Male sex increased the risk for nondipping by 2.5 times (logistic OR=2.45; 95% CI 0.87 to 6.87). However, the increase was statistically nonsignificant (P=0.08). No differences were observed between dippers and nondippers in terms of anthropometric profile, family history of hypertension, morphological and biochemical blood parameters, and birth weight.

CONCLUSIONS:

Among hypertensive children, nondippers have a more severe degree of hypertension. Male sex increases the risk of nondipping. To assess determinants of nondipping more precisely, further clinical investigations are needed.     

Transfer of immunity by means of spleen cells from mice immunized with outer membrane proteins of Shigella flexneri

Intraperitoneal immunization of mice with a single dose (5 micrograms) of outer membrane proteins (OMP) of Shigella flexneri was found to evoke in the spleen the appearance of cells by means of which immunity to lethal dose of Shigella could be transferred into other mice. Active cells capable of transferring immunity appeared in the spleen of the animals as early as on day 3, reached the strongest protective activity on day 4 and disappeared on day 8 after immunization. Active cells from animals immunized with two doses of OMP maintained in the spleens for 19 days. The experiments revealed that immunity to Shigella could be transferred only with lymphocytes; macrophages were found to be inactive.     

民族药紫丹参的本草考证

紫丹参为彝族、苗族等少数民族民间常用药物,应用广泛,但其药用历史及本草考证资料有限。该文通过系统查阅历代本草文献,结合我国几种鼠尾草属植物的形态描述和野外实地调查,对民族药紫丹参的基原、名称、药用历史、功能主治、民间应用、药理作用等进行了系统考证和整理,以期为紫丹参资源合理利用和开发提供科学依据。研究认为古代本草记载的紫丹参与今用紫丹参物种一致,为云南鼠尾草Salvia yunnanensis的根,其药用历史约600年,具有广泛的民间临床应用基础。主要用于经闭、痛经、月经不调、跌打肿痛、肢体麻木及多种血瘀证。紫丹参的相关临床应用与与现代药理学证据是相互支撑的,表明基于临床经验总结的传统医学具有较高的挖掘价值。基于本草文献考证的证据表明,紫丹参在妇科、血瘀等领域具有较高的研究开发价值,应充分挖掘紫丹参的民间临床应用经验,在此基础上,进一步加强其物质基础、药效、作用机制等相关研究,促进紫丹参的资源利用和产品开发,使其更好服务于人类。     

Squamous cell carcinoma of the colon with an elevated serum squamous cell carcinoma antigen responding to combination chemotherapy

Primary squamous cell colorectal carcinomas are uncommon, and their characteristics are not well known. They seem to occur most commonly in the fifth decade of life with a slight predominance for men. The most commonly reported anatomic locations are the rectum and the proximal colon. Clinical features and common diagnostic methods do not easily differentiate squamous cell colorectal carcinomas from adenocarcinomas. Because of their extremely rare occurrence, it is difficult to study their natural course, clinical behavior, and response to therapy. This report presents the case of a pure squamous cell colorectal cancer and provides a brief review of the literature, which includes 60 previously published cases. The case of a patient with T3N2M0 primary squamous cell carcinoma of the rectosigmoid colon, which was initially treated with abdominoperineal resection followed by adjuvant chemotherapy and radiation, is presented. During the follow-up, an elevated squamous cell carcinoma antigen (SCC Ag) level led to restaging computed tomography scans, which confirmed recurrent metastatic disease in the liver. Response to chemotherapy with a decrease in tumor size correlated with a decrease in the serum SCC Ag level. Although SCC Ag has been used as a tumor marker for squamous cell cancers of the lung, head and neck, uterine cervix, and esophagus, this is the first reported case of a squamous cell colon carcinoma presenting with an elevated SCC Ag at the time of recurrence. In addition, this patient showed an objective partial response to combination chemotherapy, with a decrease in the serum level of this tumor marker.     

The analysis of the incidence of cervical carcinomas based on the material from Histopathological Laboratory located in Zawiercie District Hospital

OBJECTIVES: The aim of the study was to analyze the incidence of malignant cervical carcinomas found in the material from Histopathological Laboratory in Zawiercie District Hospital. MATERIAL AND METHODS: The examined materials included histopathological results concerning segments and scrapings from gynecological procedures and the results of the segments, collected during gynecological operations performed in the years 2000-2005, in which malignant neoplasms of uterine cervix had been diagnosed. The data concerning the neoplasms were analysed, taking into account the following parameters: the number of neoplasms found in relation to the total number of diagnostic procedures performed, patients' age, histological type of the neoplasm and the degree of clinical progression based on FIGO classification. RESULTS: In the examined material, there were 50 cases of cervical carcinomas, with the highest incidence in patients aged between 50-59. The most common morphological type was squamous carcinoma and the majority of cervical carcinomas was characterized by the I degrees of disease clinical progression--38 cases, also 4 preinvasive carcinomas were found and 8 cancers of the II degrees of progression, according to FIGO classification. CONCLUSION: A considerable decrease of cervical carcinomas incidence, observed in the study period and the number of neoplasms found in an early progression stage are the effect of conducted screening examinations, due to which precancerous conditions are diagnosed and treated.     

The relation between cerebral blood flow velocities as measured by TCD and the incidence of delayed ischemic deficits. A prospective study after subarachnoid hemorrhage

Patients (n = 127) with aneurysmal subarachnoid hemorrhage (SAH) were examined by transcranial Doppler ultrasonography (TCD) in a prospective study to follow the time course of the posthemorrhagic blood flow velocity in both the middle cerebral artery (MCA) and in the anterior cerebral artery (ACA). Results were analysed to reveal their relationship and predictive use with respect to the occurrence of delayed ischemic deficits. Mean flow velocities (MFV) higher than 120 cm sec(-1) in MCA and 90 cm sec(-1) in ACA were interpreted as indicative for significant vasospasm. In 20 of our 127 patients (16%) a delayed ischemic deficit (DID) was subsequently diagnosed clinically (DID+ group). Patients in the DID+ group can be characterized as those individuals who presented early during the observation period post-SAH with highest values of MFV, a faster increase and longer persistence of pathologically elevated MFV-values (exceeding 120 cm sec(-1) in MCA and 90 cm sec(-1) in ACA). They also show a greater difference in MFV-values if one compares the operated to the nonoperated side. Differences in MFV-values obtained in MCA or ACA were statistically significant (p < 0.05) for DID+ and DID- patients. The daily maximal increase of MFV was found between days 9 and 11 after SAH. In the DID+ group, the maximal MFV was 181 +/- 26 cm sec(-1) in MCA and 119 +/- 14 cm sec(-1) in ACA. In contrast to this, patients in the DID- group were found to present with MFV of 138 +/- 11 cm sec(-1) in MCA and 100 +/- 7 cm sec(-1) in ACA respectively. Delayed ischemic deficits appeared three times more often in DID+ patients than in patients with MFV < 120 cm sec(-1), if they showed a MFV > 120 cm sec(-1) in MCA. If pathological values were obtained in ACA, this ratio increases to about four times, if DID + patients presented with MFV > 90 cm sec(-1) versus patients with MFV < 90 cm sec(-1). Daily monitoring of vasospasm using TCD examination is thus helpful to identify patients at high risk for delayed ischemic deficits. This should allow us to implement further preventive treatment regimens.     

Left Ventricular Diastolic Dysfunction Assessed by Conventional Echocardiography and Spectral Tissue Doppler Imaging in Adolescents With Arterial Hypertension

Compared to conventional echocardiography, spectral tissue Doppler imaging (s-TDI) allows more precise evaluation of diastolic cardiac function. The purpose of this study was to conduct s-TDI to analyze the slow movement of the left ventricular (LV) myocardium in adolescents with systemic arterial hypertension (HT) and to determine whether patients with HT suffer from LV diastolic dysfunction. The study group comprised 69 consecutive patients (48 boys and 21 girls aged 14–17 years [mean, 15.5 ± 1.1 years]) with primary HT, and the control group comprised 48 healthy participants (24 boys and 24 girls aged 14–17 years [mean, 15.8 ± 1.3 years]). Physical examinations, 24-hour arterial blood pressure monitoring, conventional 2-dimensional and Doppler echocardiography, and s-TDIs were performed. Analysis revealed that study group participants were significantly heavier and had greater LV mass indices than controls (P < 0.001). There were no differences between the velocities of E waves (peak early filling of mitral inflow), but the deceleration times of the mitral E waves were significantly shorter whereas the A waves survived longer in the study group than in the control group. The velocities of A waves (peak late filling of mitral inflow) were elevated (P = 0.041), and the E/A wave pattern (E/A = 1.8 ± 0.4) was normal. These results suggest pseudonormalization, a type of LV diastolic dysfunction in adolescents with HT.In the study group, when the sample volume was positioned at the septal or lateral insertion site of the mitral leaflet, the e′ wave velocity was significantly depressed whereas the a′ wave velocity was elevated, compared to those of the control group (P < 0.001).The e′/a′ ratios from the septal and lateral insertion sites were lower, whereas the E/e′ ratio from the septal insertion site was significantly higher in the study group, similar to that seen in atrial reversal velocity (P < 0.001).These findings indicate that using sTDI to find and measure diastolic LV failure is valuable when the probe is placed at the septal and lateral mitral valve annuli during examination.Changes in the myocardium appear similar to those seen in adults.