内皮素和内皮衍化的松弛因子在高血压发病上的作用

给予Ｗｉｓｔａｒ大鼠腹腔注射ＥＤＲＦ合成抑制剂（ＬＮＮＡ）２８ｄ，可诱发大鼠产生持续性高血压伴ＥＴ水平增高，ＥＴ／ｃＧＭＰ比值增大，主动脉环对ＥＴ的收缩反应明显增高，对乙酰胆碱（Ａｃｈ）舒张反应明显减低。然而同时给于Ｌ－精氨酸或ＥＴ抗血清可使血压降至正常，ＥＴ水平明显降低ＥＴ／ｃＧＭＰ比值缩小，使主动脉环对ＥＴ收缩反应减低，对Ａｃｈ舒张反应增加。     

人类高血压与内皮功能

１８６５年生理学家Ｈｉｓ首先提出内皮（Ｅｎｄｏｔｈｅｌｉ－ｕｍ）这一概念,其研究历史可概况如下：１９７６年Ｖａｎｅ发现内皮细胞合成并分泌前列腺素Ｉ２（ＰＧＩ２）,１９８０年Ｆｕｒｃｈｇｏｔｅ首先提出内皮依赖性舒张因子（Ｅｎｄｏｔｈｅｌｉ－ｕｍｄｅｒｉｖｅｄｒｅｌａｘｉｎｇｆａｃｔｏｒ;ＥＤＲＦ）的概念。１９８７年Ｐａｌｍｅｒ和Ｌｇａｒｒｏ提出ＥＤＲＦ为一氧化氮（ＮＯ）样物质,并发现左旋精氨酸（Ｌ－Ａｒｇｉｎｉｎｅ;Ｌ－Ａｒｇ）为ＮＯ前体。１９９３年证明ＮＯ的舒张作用由环鸟苷酸（ｃＧＭＰ）介导完成…     

精氨酸及其衍生物体外血管活性作用评价（摘要）

精氨酸及其衍生物体外血管活性作用评价（摘要）中国人民解放军空军总医院药剂科王峰，吉小莉用Ｌ－精氨酸（Ｌ－Ａｒｇ）及Ｌ－精氨酸Ｎ衍生物Ｎ－乙酰精氨酸（Ｎ－Ａｃ－Ａｒｇ）、苯甲酰Ｌ－精氨酸（Ｂｅ－Ａｒｇ）对正常血压大鼠及原发性高血压大鼠离体动脉血管的舒张...     

NO,AngⅡ对大鼠主动脉内皮细胞功能及形态学影响的实验研究

目的：通过培养的大鼠主动脉内皮细胞,观察ＡｎｇⅡ对ＥＣ分泌ＮＯ,ＥＴ－１的影响及形态学变化和ＮＯ的前体物Ｌ－Ａｒｇ 对ＡｎｇⅡ的抵消作用及对ＥＣ的保护作用。结果：随ＡｎｇⅡ浓度增高ＥＣ生成ＮＯ减低,分泌ＥＴ－１ 增加,加入Ｌ－Ａｒｇ 及卡托普利后ＮＯ生成回升,ＥＴ－１ 分泌减低;高浓度ＡｎｇⅡ及ＬＤＬ胆固醇使ＥＣ释放ＬＤＨ增加,细胞收缩。适量Ｌ－Ａｒｇ 可改善之。结论：高浓度ＡｎｇⅡ,ＥＴ－１ 及ＮＯ生成量减低可能加速ＡＳ及高血压的发生发展     

高血压病人血小板L—精氨酸／一氧化氮系统的改变

目的原发性高血压（ＥＨ）病人（２３例）与健康成年人（１４）例作对照，观察高血压时血小板（Ｐｔ）左旋精氨酸（Ｌ－Ａｒｇ）－一氧化氮（ＮＯ）系统的改变及Ｌ－Ａｒｇ转运的特征。方法微盘测定法测定血小板孵育液中亚硝酸盐（ＮＯ２－）的含量来反映ＮＯ产生量、ＡＤＰ刺激下ＮＯ的产生量；采用张新波等建立的一氧化氮合酶（ＮＯＳ）测定改良法测定血小板ＮＯＳ活性；放射性同位素标记测定血小板３Ｈ－Ｌ－Ａｒｇ转运的动力学特征。结果ＥＨ患者Ｐｔ的ＮＯ产生量及ＮＯＳ活性较对照组明显降低（Ｐ＜０．０１），用ＡＤＰ刺激后，ＥＨ患者Ｐｔ的ＮＯ增加量仅为正常对照组增加量的６０％，其Ｌ－Ａｒｇ转运能力亦显著低于正常人（各浓度点Ｐ均＜０．０１）。最大转运速率（Ｖｍａｘ）仅为正常人的７９％（Ｐ＜０．０１），而米氏常数（Ｋｍ）则无明显改变（Ｐ＞０．０５）。结论高血压时Ｐｔ的Ｌ－Ａｒｇ－ＮＯ系统存在明显异常，提示对ＥＨ患者，在降压的同时，联合应用改善Ｌ－Ａｒｇ－ＮＯ系统的药物，对预防和治疗高血压减少并发症可能会有更好的效果。     

一氧化氮对急性肝功能衰竭大鼠脏器影响的实验研究

１．资料与方祛：选用雄性Ｗｉｓｔａｒ大鼠（湖南医科大学实验动物中心提供）５０只,体重２５０～３５０ｇ,随机分为５组：假手术（ＳＯ）组、急性肝功能衰竭（ＡＬＦ）组、左旋精氨酸（Ｌ－Ａｒｇ）组、左旋甲基精氨酸甲酯（Ｌ－ＮＡＭＥ）组及Ｌ－Ａｒｇ＋Ｌ－ＮＡＭＥ组,每组１０只。切除大鼠肝左叶和中叶,右叶和尾状叶热缺血ｌｈ建立ＡＬＦ模型,Ｌ－Ａｒｇ组、Ｌ－ＮＡＭＥ组手术前后３０ｍｉｎ经尾静脉注入用生理盐水稀释的Ｌ－Ａｒｇ或Ｌ－ＮＡＭＥ;Ｌ－Ａｒｇ＋Ｌ－ＮＡＭＥ组手术前３０ｍｉｎ经尾静脉注入Ｌ－Ａｒｇ,间隔３…     

静滴L—精氨酸对原发性高血压影响的研究

从血流动力学及神经内分泌学两方面探讨左旋精氨酸（Ｌ－Ａｒｇ）－一氧化氮（ｎｉｔｒｉｃｏｘｉｄｅ，ＮＯ）通路对原发性高血压的影响。方法２６例高血压病人分为两组，一组静滴Ｌ－Ａｒｇ，一组静滴生理盐水，观察其血压、心率及心功能的变化，同时检测血中ＮＯ、ｃＧＭＰ、肾上腺素（Ｅ）、去甲肾上腺素（ＮＥ）以探讨其降压机理。结果在Ｌ－Ａｒｇ静注期间，病人血压下降，心率增快，心输出量（ＣＯ）、每搏输出量（ＳＶ）、射血分数（ＥＦ）增加，总外周阻力（ＴＰＲ）降低，ＮＯ的标志物ｃＧＭＰ升高。而在滴注６０＇时，随着ｃＧＭＰ浓度的降低，ＣＯ、ＳＶ、ＥＦ也随之降低，而ＴＰＲ复又回升。Ｅ、ＮＥ、Ｎｉｔｒｉｔｅ及Ｎｉｔｒａｔｅ在静滴前后无显著性改变。结论Ｌ－Ａｒｇ通过使ｃＧＭＰ浓度升高，引起明显的血流动力学改变；Ｌ－Ａｒｇ可能抑制血压过低所致的反应性Ｅ及ＮＥ的升高作用。     

内皮源性舒张因子对内皮损伤的大鼠胸主动脉内膜增生的影响

目的：观察内皮源性舒张因子（ＥＤＲＦ）的前体Ｌ－精氨酸（Ｌ－Ａｒｇ）和抑制剂ＷＮ－硝基－Ｌ－精氨酸（ＬＮＮＡ）对内皮损伤动脉新生内膜形成的影响。方法：采用大鼠胸主动脉内皮损伤术、氚标记的胸腺嘧啶核苷酸、（３Ｈ－ＴｄＲ）参入试验和计算机图像计量法。结果：Ｌ－Ａｒｇ（５００ｍｇｋｇ－１／ｄ静脉注射，共１４天，ｎ＝７）可明显减少内皮损伤动脉３Ｈ－ＴｄＲ参入量，降低血管新生内膜面积、新生内膜覆盖面长度、新生内膜面积／中膜面积比率、新生内膜覆盖面长度／内弹力层周长比率等指标，而ＬＮＮＡ（１５ｍｇｋｇ－１／ｄ皮内注射，共１４天，ｎ＝７）的作用恰好相反。结论：内皮源性舒张因子可通过抑制内皮损伤动脉中平滑肌细胞增殖而减轻新生内膜的形成。     

内皮源舒张因子合成抑制剂致大鼠心血管变化及意义

目的：探讨内皮源舒张因子（ＥＤＲＦ）合成受抑制时的心血管病理生理的变化及意义。方法：实验组大鼠（ｎ＝６）长期应用ＥＤＲＦ抑制剂──Ｌ－硝基精氨酸１５ｍｇ，ｋｇ~（－１）／ｄ，腹腔注射，共２８天），对照组（ｎ＝６）给予注射用水。结果：与对照组比较，Ｌ－硝基精氨酸使大鼠血压明显增高、心率减慢、心功能增强，主动脉环对去甲肾上腺素（１０~（１１）～１０~（－５）ｍｏｌ／Ｌ）和内皮素（１０~（－１０）～１０~（－６）ｍｏｌ／Ｌ）的收缩反应增强（Ｐ＜０．０５），对乙酰胆碱（１０~（－９）～１０~（－５）ｍｏｌ／Ｌ）和降钙素基因相关肽（１０~（－１０）～１０~（－８）ｍｏｌ／Ｌ）舒张反应减弱（Ｐ均＜０．０５），血浆和组织内皮素增高，主动脉组织环磷酸鸟苷活性减低，血浆血管紧张素Ⅱ和肾素活性减低，血浆丙二醛增高。肾入球小动脉内膜增厚。结论：ＥＤＲＦ对心血管有重要调控功能，ＥＤＲＦ减少可导致心血管一系列病理生理变化。     

L－精氨酸逆转一氧化氮抑制后的犬冠脉血流动力学改变和内皮素－1含量升高

观察了犬冠脉内灌注Ｎ－单甲基左旋精氨酸（Ｌ－ＮＭＭＡ）后再灌注Ｌ－精氨酸（Ｌ－Ａｒｇ）和单独灌注Ｌ－ＮＭＭＡ前后冠脉血流动力学、冠脉血流储备以及冠脉对不同浓度的乙酰胆碱（Ａｃｈ）反应的变化，同时用放免法测定冠脉前降支（ＬＡＤ）伴行静脉血中内皮素－１（ＥＴ－１）含量。结果发现，Ｌ－Ａｒｇ完全逆转了灌注Ｌ－ＮＭＭＡ引起的血流动力学改变，使心率回升，下降的基础冠脉流量（ＣＢＦ），从２０±８ｍｌ／ｍｉｎ回升至２８±７ｍｌ／ｍｉｎ，Ｐ＜０．０５），降低的冠脉储备恢复，从５１±１０ｍｌ／ｍｉｎ升至９４±１５ｍｌ／ｍｉｎ，Ｐ〈０．０１），ＥＴ－１的含量不再升高，从１５．５±３．０ｎｇ／Ｌ下降至５．０±２．０ｎｇ／Ｌ，Ｐ〈０．０１），Ａｃｈ介导的ＣＢＦ增加不再受到抑制（Ｐ〈０．０１）。结果提示提供外源性Ｌ－Ａｒｇ可增加一氧化氮（ＮＯ）的产生，使由于ＮＯ抑制而产生的血流动力学改变和ＥＴ－１升高发生逆转。     

Binding affinities of hepatic nuclear estrogen receptors for phytoestrogens in rainbow trout (Oncorhynchus mykiss) and Siberian sturgeon (Acipenser baeri)

Phytoestrogens are dietary estrogenic contaminants capable of inducing vitellogenin synthesis in rainbow trout and Siberian sturgeon. A competitive-binding assay on their hepatic estrogen receptors (ER) was performed to determine the relative affinity of phytoestrogens compared to estradiol (E(2)). Phytoestrogen concentrations used were 1000 times higher than for E(2), except for genistein and formononetin. For each compound, the competition with 50%-bound labelled E(2) (DC(50)) was considered in order to classify phytoestrogens according to their affinity for ER. The affinities are compared for each species. In rainbow trout, estradiol (DC(50): 7 nM)>formononetin (DC(50): 260 nM)>genistein (DC(50): 570 nM)>equol (DC(50): 5.3 microM)>daidzein (DC(50): 9 microM)>biochanin A (DC(50): 100 microM). In sturgeon, estradiol (DC(50): 5 nM)>genistein (DC(50): 220)>formononetin (DC(50): 1 microM)>equol>(DC(50): 8.3 microM)>daidzein>(DC(50): 80 microM)>biochanin A (DC(50): 100 microM). These results demonstrate that phytoestrogens, mimicking estradiol, can disturb the endocrine system by competing for ER. Also, the higher sensitivity to genistein observed in vivo in Siberian sturgeon (vitellogenin synthesis), compared to rainbow trout, is not due to a higher affinity of genistein for the hepatic ER. Thus, the metabolism of phytoestrogen could be species dependent and affect sensitivity.     

Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study

AIM To provide a clear understanding of viral hepatitis epidemiology and their clinical burdens in Somalia.METHODS A systematic review and meta-analysis was conducted as Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of published studies on viral hepatitis was performed from 1977-2016 in Pub Med, Google Scholar, Science Direct, World Health Organization African Index Medicus and the Africa Journals Online databases, as well as on the Ministry of Health website. We also captured unpublished articles that were not available on online systems.RESULTS Twenty-nine studies from Somalia and Somali immigrants(United Kingdom,United States,Italy,Libya)with a combined sample size for each type of viral hepatitis[hepatitis A virus(HAV):1564,hepatitis B virus(HBV):8756,hepatitis C virus(HCV):6257,hepatitis D virus(HDV):375 and hepatitis E virus(HEV):278]were analyzed.The overall pooled prevalence rate of HAV was 90.2%(95%CI:77.8%to 96%).The HAV prevalence among different age groups was as follows:1 year old,61.54%(95%CI:40.14%to79.24%);1-10 years old,91.91%(95%CI:87.76%to94.73%);11-19 years old,96.31%(95%CI:92.84%to 98.14%);20-39 years old,91.3%(95%CI:83.07%to 95.73%);and40 years old,86.96%(95%CI:75.68%to 93.47%).The overall pooled prevalence of HBV was 18.9%(95%CI:14%to 29%).The overall pooled prevalence among subgroups of HBV was20.5%(95%CI:5.1%to 55.4%)in pregnant women;5.7%(95%CI:2.7%to 11.5%)in children;39.2%(95%CI:33.4%to 45.4%)in patients with chronic liver disease,including hepatocellular carcinoma(HCC);7.7%(95%CI:4.2%to 13.6%),12.4%(95%CI:6.3%to 23.0%)and 11.8%(95%CI:5.3%to 24.5%)in age groups20 years old,20-39 years old and40years old,respectively.The HBV prevalence among risk groups was 20%(95%CI:7.19%to 44.64%)in female prostitutes,21.28%(95%CI:7.15%to48.69%)in hospitalized adults,5.56%(95%CI:0.99%to 25.62%)in hospitalized children,60%(95%CI:31.66%to 82.92%)in patients with acute hepatitis,33.55%(95%CI:14.44%to 60.16%)in patients with ancylostomiasis,12.34%(95%CI:7.24%to 20.26%)in patients with leprosy and 20.19%(95%CI:11.28%to33.49%)in schistosomiasis patients.The overall pooled prevalence of HCV was estimated as 4.84%(95%CI:3.02%to 7.67%).The prevalence rates among blood donors,risk groups,children and patients chronic liver disease(including HCC)was 0.87%(95%CI:0.33%to 2.30%),2.43%(95%CI:1.21%to 4.8%),1.37%(95%CI:0.76%to 2.46%)and 29.82%(95%CI:15.84%to 48.98%),respectively.The prevalence among genotypes of HCV was 21.9%(95%CI:15.36%to 30.23%)in genotype 1,0.87%(95%CI:0.12%to 5.9%)in genotype 2,25.21%(95%CI:18.23%to 33.77%)in genotype 3,46.24%(95%CI:37.48%to 55.25%)in genotype 4,2.52%(95%CI:0.82%to7.53%)in genotype 5,and 1.19%(95%CI:0.07%to16.38%)in genotype 6.The overall pooled prevalence of HDV was 28.99%(95%CI:16.38%to 45.96%).The HDV prevalence rate among patients with chronic liver disease,including HCC,was 43.77%(95%CI:35.09%to 52.84%).The overall pooled prevalence of HEV was46.86%(95%CI:5.31%to 93.28%).CONCLUSION Our study demonstrates a high prevalence of all forms of viral hepatitis in Somalia and it also indicates that chronic HBV was the commonest cause of chronic liver disease.This highlights needs for urgent public health interventions and strategic policy directions to controlling the burden of the disease.     

Poor clinical performance of the Wessex porcine heart valve bioprosthesis at nine years' follow up.

OBJECTIVE: To assess the long term performance of the Wessex porcine bioprostheses implanted in a consecutive series of patients. DESIGN: A retrospective case series. PATIENTS: Between January 1985 and July 1991, 184 Wessex bioprostheses (78 mitral, 102 aortic, and 4 tricuspid) were implanted in 150 patients. The patients were 55% (83/150) male and 45% (67/150) female; mean age was 60 (SD 10) years. RESULTS: Hospital mortality was 9.3% (14/150). Total follow up was 696 patient-years (mean 4.7 years per patient). Linearised rates (events per 100 patient-years (SEM) for postoperative complications for patients with isolated mitral valve replacement, isolated aortic valve replacement, and multiple valve replacement were, respectively: late mortality: 4.7 (1.6), 3.3 (0.9), and 4.9 (1.9); thromboembolism: 5.8 (1.8), 3.0 (0.9), and 2.8 (1.4); valve thrombosis: 1.0 (0.7), 0.3 (0.3), and 0.7 (0.7); structural failure: 5.8 (1.7), 1.9 (0.7), and 7.1 (2.2). Actuarial freedom from complications at nine years (70% confidence interval) was: late mortality: 61 (9)%, 57 (13)%, and 59 (12)%; thromboembolism and valve thrombosis: 71 (9)%, 79 (6)%, and 81 (8)%; structural failure: 33 (14)%, 50 (16)%, and 12 (14)%; all valve related morbidity/mortality: 31 (10)%, 21 (11)%, and 7 (9)%. Stent fractures appeared in 11 of 17 explanted prostheses; actuarial freedom from stent fracture at nine years was 66 (12)%. CONCLUSIONS: The Wessex bioprosthesis is associated with high thrombogenicity, early structural dysfunction, and a high valve related morbidity/mortality which justifies very close follow up of patients fitted with them.     

Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines

We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2–3.0), 55–64 years (AOR: 1.6, 95% CI: 1.4–1.9), and 45–54 years (AOR: 1.4, 95% CI: 1.3–1.6) age groups, females (AOR: 2.0, 95% CI: 1.7–2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0–2.8), diabetes (AOR: 1.4, 95% CI: 1.2–1.6), secondary (AOR: 1.2, 95% CI: 1.1–1.4), or college education level (AOR: 1.8, 95% CI: 1.4–2.3), middle (AOR: 1.3, 95% CI: 1.1–1.6), richer (AOR: 1.5, 95% CI: 1.2–1.8) or richest (AOR: 2.0, 95% CI: 1.6–2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2–1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3–2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.     

Depression: a predictor of smoking relapse in a 6-month follow-up after hospitalization for acute coronary syndrome.

OBJECTIVE: The objective of the study was to investigate whether depression is a predictor of postdischarge smoking relapse among patients hospitalized for myocardial infarction (MI) or unstable angina (UA), in a smoke-free hospital. METHODS: Current smokers with MI or UA were interviewed while hospitalized; patients classified with major depression (MD) or no humor disorder were reinterviewed 6 months post discharge to ascertain smoking status. Potential predictors of relapse (depression; stress; anxiety; heart disease risk perception; coffee and alcohol consumption; sociodemographic, clinical, and smoking habit characteristics) were compared between those with MD (n=268) and no humor disorder (n=135). RESULTS: Relapsers (40.4%) were more frequently and more severely depressed, had higher anxiety and lower self-efficacy scale scores, diagnosis of UA, shorter hospitalizations, started smoking younger, made fewer attempts to quit, had a consort less often, and were more frequently at the 'precontemplation' stage of change. Multivariate analysis showed relapse-positive predictors to be MD [odds ratio (OR): 2.549; 95% confidence interval (CI): 1.519-4.275] (P<0.001); 'precontemplation' stage of change (OR: 7.798; 95% CI: 2.442-24.898) (P<0.001); previous coronary bypass graft surgery (OR: 4.062; 95% CI: 1.356-12.169) (P=0.012); and previous anxiolytic use (OR: 2.365; 95% CI: 1.095-5.107) (P=0.028). Negative predictors were diagnosis of MI (OR: 0.575; 95% CI: 0.361-0.916) (P=0.019); duration of hospitalization (OR: 0.935; 95% CI: 0.898-0.973) (P=0.001); smoking onset age (OR: 0.952; 95% CI: 0.910-0.994) (P=0.028); number of attempts to quit smoking (OR: 0.808; 95% CI: 0.678-0.964) (P=0.018); and 'action' stage of change (OR: 0.065; 95% CI: 0.008-0.532) (P=0.010). CONCLUSION: Depression, no motivation, shorter hospitalization, and severity of illness contributed to postdischarge resumption of smoking by patients with acute coronary syndrome, who underwent hospital-initiated smoking cessation.     

Potassium agonists: regional vasodilator profile in rats

The systemic and regional (kidney, mesentery, hindlimb) hemodynamic effects of (a) two potassium agonists: cromakalim (1 to 8 micrograms.kg-1.min-1/15 min) and SR 44866 (0.125 to 2 micrograms.kg-1.min-1/15 min) and (b) a calcium antagonist, nicardipine (0.5 to 2 micrograms.kg-1.min-1/15 min) have been investigated by the pulsed doppler technique, and compared in the anesthetized normotensive rat. The two potassium agonists and nicardipine lowered blood pressure (BP) and total peripheral resistance (TPR) dose-dependently and slightly increased heart rate. Cardiac output (QC) remained unchanged. SR 44866 was as potent as nicardipine in reducing BP and about three to four times more potent than cromakalim (the DE20s, doses producing a 20 p. 100 decrease in BP, being: SR 44866: 0.7 micrograms.kg-1.min-1, cromakalim: 2.8 micrograms.kg-1, nicardipine: 0.8 micrograms.kg-1.min-1). At these equihypotensive doses, the three drugs (a) similarly decreased TPR (SR 44866: -16 p. 100, cromakalim: -17 p. 100, nicardipine: -19 p. 100, (b) reduced mesenteric vascular resistance (MVR) (SR 44866: -18 p. 100, cromakalin: -20 p. 100, nicardipine: -21 p. 100) and renal vascular resistance (RVR) (SR 44866: -16 p. 100, cromakalim: -21 p. 100, nicardipine: -13 p. 100 to the same extent as TPR, but (c) SR 44866 and nicardipine reduced hindlimb vascular resistance (HVR) to a larger extent than TPR (SR 44866: -25 p. 100, nicardipine: -25 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)     

Angiotensin II receptors from peritransplantation through first-year post-transplantation and the risk of transplant coronary artery disease

OBJECTIVES: We evaluated whether the angiotensin II (Ang II) receptors from perioperation through one-year post-transplantation predict the transplant coronary artery disease (TCAD) progression. BACKGROUND: The role of Ang II receptors (type 1: AT(1)R; type 2: AT(2)R) in TCAD is uncertain. METHODS: We investigated 28 heart donors and the corresponding recipients. The levels of AT(1)R and AT(2)R messenger ribonucleic acid (mRNA) were examined in lymphocytes from the donor spleen and in the donor heart at one-week and one-year posttransplantation to determine their association with the progression of TCAD, measured as changes in maximal intimal thickness (CMIT) and plaque volume (CPV) by intravascular ultrasound (IVUS) examinations. RESULTS: The AT(1)R mRNA in lymphocytes from the donor spleen (CMIT: r = 0.73, p < 0.0001; CPV: r = 0.69, p < 0.0001) and in the donor hearts at one-week (CMIT: r = 0.52, p = 0.005; CPV: r = 0.56, p = 0.002) and at one-year (CMIT: r = 0.63, p < 0.0001; CPV: r = 0.43, p = 0.004) post-transplantation along with AT(2)R mRNA in the donor hearts at one-year post-transplantation (CMIT: r = 0.3, p < 0.0001; CPV: r = 0.53, p = 0.009) were univariate predictors, whereas AT(1)R mRNA in lymphocytes and in the donor hearts at one-year post-transplantation proved to be multivariate predictors of the progression of TCAD. CONCLUSIONS: These data suggest a role for Ang II receptors in the pathogenesis of TCAD and support a novel concept that TCAD may have its origin in the donor per se and may be modulated by the recipient's inherent biological factors.     

Comparison of 1- and 2-week pantoprazole-based triple therapies in clarithromycin-sensitive and resistant cases

BACKGROUND: The objectives of this prospective study were: (i) to compare the efficacy of 1-week with 2-week pantoprazole-based triple therapy and (ii) to evaluate the impact of clarithromycin resistance on Helicobacter pylori (H. pylori) eradication rates. METHODS: Eighty dyspeptic patients were randomly allocated to two groups. The first group (PAC-1, n=40) received pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice a day for one week, and the second group (PAC-2, n=40) received the same regimen for two weeks. Endoscopy was repeated one month after the end of the treatment. RESULTS: DNA extraction for clarithromycin resistance could not be performed in seven cases. Five cases were lost to follow-up. Clarithromycin resistance was found to be 44.1% (15/34) in the PAC-1 group and 58.8% (20/34) in the PAC-2 group (p>0.05). Eradication was achieved in 16 (PP: 47.1%, ITT: 44.4%) and 25 (PP:73.5%, ITT: 67.6%) patients in the PAC-1 and PAC-2 groups, respectively (p>0.05). H. pylori was eradicated in 4 of 15 (PP: 26.7%, ITT: 26.7%) clarithromycin-resistant patients in the PAC-1 group and in 12 of 20 (PP: 60%, ITT: 60%) clarithromycin-resistant patients in the PAC-2 group (p>0.05). Among the clarithromycin-sensitive ones, eradication was achieved in 12 of 19 (PP: 63.2%, ITT: 57.1%) patients in the PAC-1 group and in 13 of 14 (PP: 92.8%, ITT: 76.5%) patients in the PAC-2 group (p>0.05). CONCLUSION: Although the 2-week regimen of pantoprazole-based triple therapy was effective for H. pylori eradication in clarithromycin-sensitive cases, highly effective H. pylori eradication protocols are needed for clarithromycin-resistant ones.     

Clinical pharmacology of enalapril in hypertension with chronic renal failure

The effects of a single oral dose of enalapril (20 mg) on blood pressure (BP), heart rate (HR) plasma renin activity (PRA) aldosterone (PA), converting enzyme inhibition (CEI) and enalaprilat (E, active metabolite) were investigated during 96 h in 3 groups of 5 hypertensive patients with (1) normal renal function (creatinine clearance: Clcr greater than 80 ml.min-1); (2) moderate chronic renal failure: 80 greater than or equal to Clcr greater than 30 ml.min-1; (3) severe chronic renal failure: 30 greater than or equal to Clcr greater than 10 ml.min-1. Results are as follows (mean +/- SEM): (Table: see text) CEmax: maximal plasma concentration; TEmax: delay corresponding to CEmax; TE 1/2: plasma elimination half-life; AUCE: area under plasma level versus time curve. a: p less than 0.01; b: p less than 0.001; versus (1). In the 3 groups, CEI reached 87-94% as early as the 3rd h; however, at 96 h, CE1 was higher in (3) than in (1) and (2): 77.6 +/- 3.3% versus 6.0 +/- 1.6 and 17.7 +/- 4.8 (p less than 0.001 respectively). In (3). PRA increased at the 1st h and remained elevated: at 96 h, delta PRA was + 3.0 +/- 2.9 ng.ml-1 -.h-1 in (3) versus + 0.10 +/- 0.06 and + 0.25 +/- 0.17 ng.ml-1.h-1 .n (1) and (2) [(3) versus (1): p less than 0.01]; delta PA was lower in (3): -4.56 +/- 2.01 ng. 100 ml-1 versus -0.54 +/- 0.31 and -2.50 +/- 0.38 ng. 100 ml-1 [(3) versus (1): p less than 0.05].(ABSTRACT TRUNCATED AT 250 WORDS)     

Indications and therapeutical options in hepatolithiasis.

OBJECTIVE: to present our experience with the treatment of hepatolithiasis. PATIENTS AND METHODS: EXPERIMENTAL DESIGN: a retrospective study. Every patient operated on during 2002-2004. RESULTS: mean age was 68.2 years. All patients were male. Two patients had been operated on before. The other three suffered from: monolobar Caroli s disease (1), cholangiocarcinoma (1), and hepatolihtiasis without clear etiologic factors (1). All of them had intrahepatic and extrahepatic litihiasis. Clinical signs included: pain in RUQ, fever, and jaundice. Bilirubin was 3.5 mg/dl (min: 1.7, max: 5.9), GGT: 676.2 IU/l (min: 29, max: 2039), and alkaline phosphatase: 400 IU/l (min: 100, max: 1136). Abdominal ultrasounds always correctly diagnosed HL. CT (3 patients) only diagnosed one case. ERCP (3 patients) and cholangio-MRI (2 patients) always diagnosed HL correctly. Surgical procedures were: hepatojejunostomy with lavage of bile duct (2 cases) and hepatectomy (3 cases) -both right (1) and left (2). We always performed an intraoperative ultrasonography and choledoscopy. Morbidity was: biliary fistula (1 case) treated by percutaneous drainage. No mortality occurred. Median stay was 8.8 days. Mean follow-up is 12 months (min: 11, max: 20). No relapse has been observed. CONCLUSIONS: HL is infrequent in Spain. Surgical treatment, usually liver resection, obtains good results with low morbidity and mortality.