What is the role of dietary sodium and potassium in hypertension and target organ injury?

There is substantial evidence from both observational epidemiology studies and randomized controlled trials that dietary intake of sodium and potassium is important in the etiology of hypertension. However, the direct evidence for a direct link between dietary sodium and potassium and risk of cardiovascular and renovascular events is limited. Epidemiological studies should be designed to examine the relationship between dietary intake of sodium and potassium and risk of stroke, coronary heart disease, left ventricular hypertrophy, and renal disease in a prospective manner. In these studies, dietary intake of sodium and potassium should be estimated using multiple 24-hour urine collections. These studies should be focused on African Americans because they are at a disproportionately high risk of developing hypertension and blood pressure-related vascular disease. Moreover, this group has been underrepresented in most previous epidemiological studies.     

What is the role of adiponectin in obesity related non-alcoholic fatty liver disease?

Non-alcoholic fatty liver disease (NAFLD) is recognized as the most common type of chronic liver disease in Western countries.Insulin resistance is a key factor in the pathogenesis of NAFLD,the latter being considered as the hepatic component of insulin resistance or obesity.Adiponectin is the most abundant adipose-specific adipokine.There is evidence that adiponectin decreases hepatic and systematic insulin resistance,and attenuates liver inflammation and fibrosis.Adiponectin generally predicts steatosis grade and the severity of NAFLD;however,to what extent this is a direct effect or related to the presence of more severe insulin resistance or obesity remains to be addressed.Although there is no proven pharmacotherapy for the treatment of NAFLD,recent therapeutic strategies have focused on the indirect upregulation of adiponectin through the administration of various therapeutic agents and/or lifestyle modifications.In this adiponectin-focused review,the pathogenetic role and the potential therapeutic benefits of adiponectin in NAFLD are analyzed systematically.     

What is the role of the microenvironment in MDS?

Treating myelodysplastic syndromes (MDS) remains challenging. Hematopoiesis occurs within a heterogeneous, complex and dynamic microenvironment, and a multiplicity of mutations in hematopoietic stem and progenitor cells (HSPCs) lead to MDS. But is there a role for the microenvironment? Here we review experimental and conceptual arguments that support a role for the microenvironment, provide evidence for the disruption of the microenvironment in MDS, and explore microenvironmental signals that may provide a targetable and conserved vulnerability in MDS that transcend genetic heterogeneity.     

What is the role of airway pressure release ventilation in the management of acute lung injury?

The lack of published evidence supporting the use of APRV in the pediatric critical care patient population may diminish its effective application in respiratory failure. The effect of APRV on the number of ventilator days, ICU stay, and mortality still remains to be studied. Further application of APRV in the role of rest settings for ECMO especially in the pediatric cardiac patient population needs to be investigated. Will the use of APRV decrease the time for adequate lung recruitment, decrease sheer trauma, and/or promote earlier decannulation upon the restoration of tolerable cardiac function? Can APRV be utilized as a re-recruitment maneuver? A comparison of APRV over sustained in a randomized-controlled fashion, will there be a significant difference in ventilator days, length of ICU stay, and/or mortality? Does re-recruitment at plateau pressures during suctioning, patient position changes, or in the face of increased airway resistance decrease the number of ventilator days, length of ICU stay, and/or mortality? Does the use of continuous monitoring of carbon dioxide production aid in optimizing P(high)? The list of questions, both speculative and scientific are too numerous to list. Speculation leads to inquiry which over time drives science. More focus is needed on randomized, controlled trials. Initially the comparison of APRV to HFOV needs to be the primary focus for a proactive approach for ALI. Once a comfort level is established with this modality, further scientific inquires will follow. In the meantime, its use is likely to remain controversial.     

What is the role of falls?

There is now firm evidence to support interventions in the prevention of falls in older people, and emerging data support prevention of falls as a method of fracture prevention. This chapter discusses the epidemiology of falls, risk factors associated with an increased risk of falling, assessment of the older faller, and evidence-based approaches to the prevention of falls in the older person. Several randomized controlled trials have found that hip protectors, if worn, probably prevent hip fractures, but that poor compliance is a major issue limiting the effectiveness of this form of intervention. More data are needed to support the role of prevention of falls in preventing fractures, as well as comparative cost-effectiveness data with other evidence-based approaches to preventing fractures in an older population.     

What is new in the 2018 Chinese hypertension guideline and the implication for the management of hypertension in Asia?

The new Chinese hypertension guideline comprehensively covers almost all major aspects in the management of hypertension. In this new guideline, hypertension remains defined as a systolic/diastolic blood pressure of at least 140/90 mm Hg. For risk assessment, a qualitative approach is used similarly as in previous Chinese guidelines according to the blood pressure level and the presence or absence of other risk factors, target organ damage, cardiovascular complications, and comorbid diseases. The therapeutic target is 140/90 mm Hg in general, and if tolerated, especially in high‐risk patients, can be more stringent, that is, 130/80 mm Hg. However, a less stringent target, that is, 150/90 mm Hg, is used in the younger (65‐79 years, if tolerated, 140/90 mm Hg) and older elderly (≥80 years). Five classes of antihypertensive drugs, including β‐blockers, can be used either in initial monotherapy or combination. The guideline also provided information on the management of hypertension in several special groups of patients and in the presence of secondary causes of hypertension. To implement the guideline recommendations, several nationwide hypertension control initiatives are being undertaken with new technology. The new technological platforms hopefully will help improve the management of hypertension and generate scientific evidence for future hypertension guidelines, including a possible Asian hypertension guideline in the near future.     

What is the prevalence of resistant hypertension in the United States?

Purpose of review Resistant hypertension, defined as blood pressure uncontrolled on three, or controlled with at least four, antihypertensive agents (including a diuretic), is associated with higher risk of secondary hypertension, cardiovascular and renal events, and increased healthcare expenditures. Until recently, however, the prevalence of resistant hypertension in the United States (US) was based on clinical trial registries or pharmacy databases. Recent findings Recent analyses of National Health and Nutrition Examination Survey (NHANES) data, drawn from representative samples of the adult, noninstitutionalized, civilian population, have estimated the prevalence of resistant hypertension at 8.9 ± 0.6% of the US hypertensive population in 2003-2008. A time-sequence comparison of NHANES data from 1998 through 2008 suggests that, unlike hypertension, resistant hypertension is becoming more prevalent (e.g., 20.7% in 2005-2008), due to aging and increased obesity in the general population. Resistant hypertension was more frequent in people who were older, obese, male, African American or nonblack Hispanic. Summary In coming years, even if the prevalence of hypertension remains stable, resistant hypertension is likely to increase, especially as the proportion of treated hypertension increases. Because of increased use of healthcare resources, resistant hypertensive patients should be identified early, and greater efforts made to control their blood pressures.     

What is the role of giant cells in AL-amyloidosis?

AL-amyloidosis is one of the most common amyloidoses and can be found in a localized and a systemic form. The precursor protein is an immunoglobulin light chain which as AL-protein in both localized and systemic AL-amyloidosis shows the same pattern of fragmentation and changes of primary structure. In this work it is shown that that there is a difference between localized and systemic amyloidosis in respect to accompanying giant cells which constantly are found associated with amyloid deposits in localized AL-amyloidosis. In addition, giant cells were found together with amyloid deposits in lymph nodes of some cases of systemic AL-amyloidosis. Based on these findings and electron microscopic studies, it is discussed whether the giant cells actively participate in amyloid fibril formation by uptake and modification of the precursor protein or the giant cells are part of a foreign body reaction. Included in this work are two new cases of localized lung (lambda I) and ureteric (kappa I) AL-amyloidosis.     

What is the role of endoscopy and oesophageal biopsies in the management of GERD?

Gastroesophageal reflux disease (GERD) is a diagnosis applicable to “all individuals who are exposed to the risk of physical complications from gastroesophageal reflux, or who experience clinically significant impairment of health related well being (quality of life) due to reflux related symptoms, after adequate reassurance of the benign nature of their symptoms”. It remains, predominantly, a symptom-based diagnosis, confirmed clinically by a response to acid suppression therapy although it is accompanied by demonstrable increases in acid exposure on esophageal pH-metry and by endoscopic and histological changes. Standard white light endoscopy permits diagnosis of erosive reflux disease (ERD) which, if present, should be graded for severity using the Los Angeles classification system. However, the role of endoscopy in clinical practice is, primarily, to evaluate patients with persistent symptoms, despite medical therapy, or to investigate alarm features and exclude complications such as Barrett’ oesophagus which should be assessed using the Prague C & M criteria. Newer endoscopic techniques allow detection of ‘minimal change’ GERD lesions and Barrett's oesophagus-associated dysplastic or neoplastic lesions; however, none of the newer techniques has been validated for routine clinical practice. There is an increasing recognition that histology in GERD may provide useful diagnostic information, in part to exclude other lesions, such as eosinophilic oesophagitis, intestinal metaplasia and dysplasia or malignancy and, in part, to identify changes, such as basal cell hyperplasia, papillary elongation and, most recently, dilated intercellular spaces, that are consistent with GERD. However, more widespread incorporation of histology into the clinical management of GERD will require a standardized biopsy protocol and efforts to minimise interobserver differences in the identification of GERD-related histological changes.     

What is the role and significance of serum and stool biomarkers in the diagnosis of IBD?

Biomarkers hold promise for identifying high-risk individuals who may go on to develop IBD as well as prognosticate disease behavior. Stool markers have not been readily accepted but may be more sensitive and specific than our serum biomarkers for evaluating disease activity. Ultimately, genomic and proteomic approaches will be used to identify novel biomarkers in IBD.