A RANDOMIZED CONTROLLED TRIAL OF WEIGHT REDUCTION AND METOPROLOL IN THE TREATMENT OF HYPERTENSION IN YOUNG OVERWEIGHT PATIENTS

The effects of weight reduction and metoprolol (100 mg, b.d.) in the treatment of hypertension (diastolic blood pressure 90-109 mmHg) in 56 young, overweight patients were investigated in a randomized placebo controlled trial. After a 4-week baseline, subjects were followed up for 21 weeks. In the weight reduction group, the fall in systolic and diastolic blood pressure (13/10 mmHg), associated with a mean group weight loss of 7.4 kg, was greater (P less than 0.001) than that in the placebo group (7/3 mmHg); the fall in diastolic pressure but not systolic pressure was also greater than that in the metoprolol group (10/6 mmHg). At the end of follow-up, 50% of the weight reduction group, 39% of the metoprolol group and 17% of the placebo group had a diastolic blood pressure of less than 90 mmHg. In the weight reduction group there was a fall in total cholesterol and the ratio of total to HDL-cholesterol (P less than 0.001); in the metoprolol group there was a fall in HDL-cholesterol and an increase in the ratio of total to HDL-cholesterol (P less than 0.001). The results suggest that in the first step of treatment for hypertension in overweight patients, modest weight reduction produces significant and clinically important reductions in blood pressure, without incurring the adverse effects on plasma lipids and lipoproteins often associated with the first step of drug therapy.     

Double-blind placebo-controlled trial of terazosin effect on blood pressure and urinary output of dopamine in hypertensive patients.

In a parallel, double-blind study, 12 untreated hypertensive patients received terazosin (2-4 mg/day for 4 weeks), and 12 received placebo during the same period. Systolic and diastolic blood pressure decreased significantly in the terazosin group, from 150 +/- 5.0 mmHg systolic and 99.6 +/- 2.0 diastolic before treatment, to 134.0 +/- 7.0 systolic and 85.6 +/- 3.0 mmHg diastolic at week 4 of treatment. No significant blood pressure changes occurred in the placebo group. Blood pressure decrease showed a positive correlation (r = .62 and r = .52 for systolic and diastolic blood pressure, respectively) with the patient's age (P less than .05). Total plasma cholesterol decreased 18% in the terazosin group (P less than .05) and 9% in the placebo group (P greater than .05). Urinary dopamine excretion decreased significantly from 692.8 +/- 180.0 to 330.5 +/- 52.0 micrograms/24 hours in the terazosin group (P less than .05) and showed a nonsignificant increase in the placebo group. Compared with 22 age- and sex-matched healthy volunteers, urinary dopamine excretion in the hypertensive group before treatment was not statistically different (779.3 +/- 83.1 micrograms/24 hours). Dopamine excretion was higher in untreated hypertensive men and in male healthy volunteers compared with women. The decrease of urinary dopamine excretion observed under terazosin treatment could be due to a decrease of kidney dopamine synthesis or release induced by blood pressure reduction, or secondarily to the blockade of kidney alpha 1-receptors, modulating dopamine excretion. No significant changes were observed in urinary excretion of noradrenaline and adrenaline.     

Dose-dependent effects of betaxolol in hypertension: a double-blind, multicenter study.

This study determined the dose-response relationship among three doses of betaxolol compared with placebo in patients with mild-to-moderate hypertension. In this double-blind, placebo-controlled trial, 317 hypertensive patients were randomly assigned to receive placebo or betaxolol 5, 10, or 20 mg once daily for 4 weeks. A significant (P less than .05) decrease in supine diastolic blood pressure (BP) compared with concurrent placebo was evident with all three doses of betaxolol after 1 week of active treatment. Each dose of betaxolol maintained a significant reduction in diastolic and systolic BP and heart rate responses throughout the 4-week treatment period. At the fourth week (final treatment evaluation), BP and heart rate were significantly (P less than .05) reduced by all three doses of betaxolol compared with placebo. For supine systolic and diastolic BP, the decreases with betaxolol 20 mg were significantly (P less than .05) greater than with the 5 mg dose, but there was no statistically significant difference between the 10-mg and either the 5- or 20-mg doses. For standing diastolic BP, the effect of betaxolol 5 mg once daily was significantly (P less than .05) less than that of 10 and 20 mg. The overall supine diastolic BP response to betaxolol was dose dependent, and more patients responded to the 10- and 20-mg doses of betaxolol (66% and 76%, respectively) than to the 5-mg dose (59%). For each efficacy variable, the absolute magnitude of the reduction was greater with increasing dose. In subgroup analyses, BP responses were analyzed by race, age, baseline BP, and age combined with baseline BP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Combined effect of bumetanide and metolazone in normal volunteers

Bumetanide 1 to 2 mg or metolazone 2.5 mg were administered by mouth separately and then in combination to eight normal men and women in order to determine whether a sequential blockade of sodium reabsorption with diuretic agents that act at different sites within the nephron leads to a supra-additive diuretic effect. All three treatment regimens resulted in a significant weight loss and increased urine volume and the excretion of sodium, potassium, and chloride. A prolonged diuretic effect lasting up to 48 hours after administration occurred with metolazone alone. Although absolute and fractional chloride and potassium excretion and urine volume were higher after combined therapy (P less than .05 or better) than after either drug alone, absolute sodium excretion after combination therapy was higher than excretion after bumetanide (P less than .05) but not after metolazone. The percent of fractional sodium excretion after both drugs was greater than after either drug alone (P less than .05). However, excretion of chloride, sodium, potassium, and fluid on the combined therapy day was less than the sum of excretion on each single drug therapy day. Thus, the combination of bumetanide and metolazone did not have a supra-additive effect in normal subjects.     

Effect of yogasanas on the visual and auditory reaction time

Visual and auditory reaction time (VRT, ART) was studied in 83 healthy male subjects of 30-40 years of age who had never practiced yogasanas before. These subjects were divided into two groups viz. Group A whose VRT and ART was determined after 1 hr. yogasanas and Group B whose ART and VRT was determined after 6 weeks yogasanas training programme. VRT and ART showed a significant reduction in Group A (P less than .05) and Group B (P less than .001).     

Dyslipoproteinaemia in Nigerians with the nephrotic syndrome (an increased risk for ischaemic heart disease?)

Plasma lipids and lipoproteins were measured in 24 Nigerians with the nephrotic syndrome and 29 healthy subjects. None of the patients had been commenced on treatment. Plasma total cholesterol, low density lipoprotein (LDL) cholesterol group (P less than 0.005). By contrast, the HDL-cholesterol to total cholesterol ratio as well as the HDL-cholesterol concentrations were found to be significantly lowered in the nephrotics than the controls (P less than 0.005). A strong correlation was observed between plasma total cholesterol and LDL cholesterol values but not between the other biochemical parameters (r = 0.98.P less than 0.01). These results, though not definitive, suggest that Nigerians with the nephrotic syndrome may represent a risk group for the development of ischaemic heart disease. Long term prospective studies in such patients are desirable to define the effect of these lipid and lipoprotein abnormalities.     

Peripheral hemodynamic and humoral effects of oral zofenopril calcium (SQ. 26,991) in patients with congestive heart failure

In 14 patients with congestive heart failure (CHF) of various grade (NYHA class 2-4) the effects of zofenopril calcium (SQ 26,991) on blood pressure and forearm circulation were studied by venous occlusion plethysmography. Changes in plasma renin activity (PRA), aldosterone, Atrial natriuretic factor (ANF) and arginine-vasopressin (AVP) were also measured. Two hours after oral administration of 7.5 mg of zofenopril we observed a decrease in blood pressure, heart rate, and forearm vascular resistance along with an increase in venous distensibility. Zofenopril also decreased ANP levels in a manner directly related to peripheral venodilatation (r = .64; P less than .05) and modified arginine-vasopressin (AVP) proportionally to the fall in blood pressure observed in response to drug administration (%SBP/%AVP: r = .64, P less than .05; %DBP/%AVP: r = .67, P less than .05). Hemodynamic and humoral responses to zofenopril occurred without any significant unwanted adverse reaction, even in patients with greater pressor reduction. We conclude that oral acute zofenopril administration, in patients with congestive heart failure, causes an arterial and venous forearm vasodilatation which is probably involved in the acute changes in plasma levels of ANF and AVP observed after drug administration.     

不同时期 GDM 和妊娠期高血压患者甲状腺功能异常的关系

目的：探讨不同孕期妊娠期糖尿病和妊娠期高血压患者与甲状腺功能异常的相关性。方法回顾分析480例孕妇临床资料,其中96例妊娠期糖尿病为糖尿病组,52例妊娠期高血压分为高血压组,332例正常孕妇分为对照组。统计3组孕妇的游离甲状腺素（FT4）水平、促甲状腺激素（TSH）水平,比较二者在孕早期、孕中期、孕晚期的变化趋势及平均水平。分析3组孕妇的各类甲状腺功能异常以及轻度甲状腺功能异常的发病情况。结果孕中期的FH4水平,糖尿病组和高血压组均比对照组低（ P ﹤0.05）;孕中期的 FT4下降率,糖尿病组较对照组高（ P ﹤0.05）;孕中期的 TSH 水平,高血压组较对照组高（ P ﹤0.05）;孕晚期的 TSH 水平,糖尿病组和高血压组均较对照组高（ P ﹤0.05）;3组孕妇 TSH 平均水平随着孕期增加呈上升趋势,但差异无统计学意义（ P ﹥0.05）。孕晚期,累计的临床甲亢发病率、临床甲减、亚临床甲亢在3组间差异无统计学意义（ P ﹥0.05）;累计的亚临床甲减发病率,糖尿病组和高血压组比对照组均高（ P ﹤0.05）;累计的低 T4血症发病率,糖尿病组和高血压组均比对照组高（ P ﹥0.05）;孕晚期,轻度甲状腺功能异常发生率在糖尿病组比对照组高（ P ﹥0.05）,而高血压组与对照组之间差异无统计学意义（χ2＝3.82,P ＝0.096）。结论相较于正常孕妇,妊娠期高血压及妊娠期糖尿病患者具有更高的 TSH、更低的 FT4水平和较高的轻度甲状腺功能异常的发病率,临床上对这些患者的甲状腺功能情况应该给予更多的关注和检测。     

The influence of transdermal oestradiol replacement therapy and medroxyprogesterone acetate on serum lipids and lipoproteins

Aims The objective of this study was to examine the effects of continuous transdermal oestradiol with or without sequential oral medroxyprogesterone acetate on serum lipids and lipoproteins in menopausal women.
Methods Sixty-two healthy menopausal women, attending at two menopause clinics in Western India, were recruited for this study over a period of 1 year. Group 1 included 38 hysterectomised women being treated with continuous transdermal oestradiol only (50  μg daily). Group 2 included 24 menopausal women with an intact uterus being treated with transdermal oestradiol (50  μg daily) and medroxyprogesterone acetate (10  mg daily for the first 12 days of each calendar month). Women maintained on 50  μg oestradiol throughout 6 months (group 1: n =22; group 2: n =16) were reviewed for changes in serum lipids and lipoproteins at the end of 6 months (group 1), and between days 8 and 12 of the seventh month (combined phase of treatment) (group 2).
Results In group 1, there was a small reduction in the concentrations of total cholesterol (−5.5%, P =0.04) and a small but not significant reduction in LDL-cholesterol (−5.7%, P =0.16). In group 2, there were no significant changes in total cholesterol (−4.2%, P =0.43) and LDL-cholesterol (−3.9%, P =0.57). HDL-cholesterol levels did not change significantly with unopposed transdermal oestradiol (+3.0%, P =0.53), or with additional sequential medroxyprogesterone acetate (−3.8%, P =0.32). Serum triglyceride concentrations decreased significantly in both the groups (−13.9%, P =0.01, and −13.4%, P =0.008, respectively). Serum lipid changes did not differ between the groups.
Conclusions Transdermal oestrogen therapy appears to be of particular benefit for women with hypertriglyceridaemia. There were no significant adverse effects of medroxyprogesterone acetate on serum lipids and lipoproteins.     

高龄重度子痫前期孕妇心脏形态与功能的变化

目的 超声心动图检查分析高龄重度子痫前期孕妇心脏形态及功能的变化.方法 选取2016年4月-2018年10月于河北省人民医院行超声心动图检查的孕妇204例,其中重度子痫前期单胎孕妇118例,正常妊娠单胎孕妇86例(正常组).将118例重度子痫前期孕妇按年龄分为高龄重度组(n=47)和重度组(n=71),比较3组超声心动...     

Effect of dietary fibre on oral glucose tolerance test

Role of dietary fibre in lowering blood sugar levels has been studied in mongrel dogs. Pectin, wheat bran, guargum and Isabghol were fed with standard diet. Blood sugar levels were almost the same on 7th day (P less than .05). However, after 15 days pectin reduced blood sugar levels significantly (P less than .05), while other dietary fibre could not bring significant effect on blood sugar levels (P less than .05).     

卡前列素氨丁三醇与米索前列醇防治高危孕妇剖宫产术后产后出血的临床观察

目的比较卡前列素氨丁三醇与米索前列醇对高危产妇剖宫产术产后出血的防治价值。方法将102例行剖宫产分娩的高危产妇随机分为2组。A组52例,给予卡前列素氨丁三醇肌注;B组50例,给予米索前列醇塞肛治疗。比较两组产后出血率、产后2 h及24 h出血量。结果两组产后出血率比较差异无统计学意义(P>0.05);A组产后2 h及24 h出血量均少于B组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论卡前列素氨丁三醇对产后出血的防治效果优于米索前列醇,可提高子宫收缩率,减少产后出血率。     

The effects of gender and gonadal steroids on the neuroendocrine and temperature response to m-chlorophenylpiperazine in leuprolide-induced hypogonadism in women and men.

Studies of the effects of gender and gonadal steroids on serotonergic activity in humans are few in number and often contradictory. We examined the neuroendocrine and core temperature response to a serotonergic stimulus, m-chlorophenylpiperazine (m-CPP) (0.08 mg/kg body weight, IV), in asymptomatic female and male volunteers during induced hypogonadism (leuprolide acetate) and hormone replacement (estradiol (E2) or progesterone (P4) in women; testosterone (T) in men).Compared with the hypogonadal state, basal prolactin (PRL) secretion was significantly higher during both P4 and E2 replacement (p <.05) in women and during T replacement in men (p <.05). m-CPP stimulated PRL secretion was significantly greater only during P4 (p <.05) but not E2 (women) or T (men) replacement, compared with hypogonadism. Basal but not stimulated plasma growth hormone (GH) levels were significantly higher during P4 in women and T in men (p <.05), and no significant differences in basal or m-CPP stimulated plasma levels of ACTH or cortisol were observed. Finally, basal core temperatures were significantly higher during P4 replacement compared with either E2 replacement or the hypogonadal condition (p <.01) in women, with no differences observed in men. Comparisons of measures by gender (and matched for baseline plasma T levels) revealed that during the hypogonadal state m-CPP-stimulated GH secretion was significantly greater (p <.01) and m-CPP-stimulated ACTH (p <.05) and cortisol (p <.01) significantly less in women compared with men.Although our data are limited to those components of the central serotonergic system influenced by m-CPP administration, our findings suggest the following: the regulatory effects of gonadal steroids on serotonergic function are modest in humans during leuprolide-induced hypogonadism; menstrual cycle phase effects of serotonergic agents on PRL secretion may reflect both the effects of P4 and E2; the effects of P4 in humans may occur without E2 priming of the progesterone receptor; and gender differences in GH secretion occur independent of the presence of gonadal steroids.     

内镜下甲状腺良性肿瘤切除术的疗效观察

目的观察内镜下甲状腺良性肿瘤切除术的疗效。方法60例甲状腺良性肿瘤患者随机分为内镜组和传统组,每组各30例。比较两组的手术时间、失血量、引流量、术后住院时间、术后并发症、住院费用等。结果两组术后住院时间差异（P〉0．05）;内镜组失血量（25．3±15．6）m1,明显少于传统组的（57．2±33．8）ml（P〈0．05）;内镜组术后引流量（85．6±53．2）ml,明显多于传统组（23．5±37．2）ml（P〈0．05）;内镜组手术时间为（105．3±23．5）min,与传统组（80．4±25．3）min比较差异有统计学意义（P〈0．05）;住院费用内镜组明显高于传统组（P〈0．05）。两组术后均未发生明显并发症。结论与传统开放手术相比,良性甲状腺肿瘤的内镜手术具有美容、出血少等优点,是治疗该疾病一种很好的选择。     

瘢痕子宫产妇剖宫产术出血量分析

目的观察剖宫产术的瘢痕子宫产妇术中、术后出血量的变化。方法对36例剖宫产分娩的瘢痕子宫产妇,采用称重法精确测量术中、术后出血量,同期选取98例剖宫产分娩的正常产妇作为对照。结果瘢痕子宫组术中出血量为（372．4±180．0）ml,术后2h内总出血量为（444．7±228．2）ml,术后24h内总出血量为（527．4±251．6）ml,均高于对照组（P〈0．05）。瘢痕子宫组产后出血发生率为47．2％,高于对照组（P〈0．05）。瘢痕子宫组与对照组在手术前后Hb及凝血功能变化无明显差异（P〉0．05）。结论瘢痕子宫是导致剖宫产产后出血增加的重要原因,临床处理需加强剖宫产术中失血的防治。     

The effect of dietary fiber on the bioavailability of digoxin in capsules

Sixteen healthy volunteers were regularly given 0.4 mg of digoxin daily as two capsules with breakfast. After ten days during which breakfast was supplemented with 11 g of bran fiber, steady-state predose mean serum digoxin was lower (0.89 +/- 0.19 versus 0.84 +/- 0.18 ng/mL, P less than .05) and mean 24-hour area under curve determination was lower (30.5 +/- 6.1 versus 28.4 +/- 6.0 ng X hr/mL, P less than .05) than during the control period without bran. Height and time of peak serum digoxin, and 24-hour urinary digoxin were not significantly different. The 6 to 7% reduction in digoxin absorption from capsules is less than that reported from tablets and is probably clinically unimportant.     

三种宫内节育器临床效果观察

目的观察吉妮IUD、元宫IUD和Tcu380AIUD的临床效果。方法对分别放置吉妮IUD、元宫IUD和Tcu380AIUD的育龄妇女各202例,进行24个月观察和随访。结果妊娠率三组间比较差异无统计学意义（P〉0.05）;脱环率和因症取出率在放置18、24个月吉妮组和元宫组均比Tcu380A组减少（P〈0.05）;续用率在放置18、24个月吉妮组、元宫组均比Tcu380A组增多（P〈0.05）;吉妮组与元宫组3、6个月的月经量增多、经期延长、不规则出血、腰腹胀痛、白带增多等不良反应均比Tcu380A组减少（P〈0.05）。结论吉妮IUD和元宫300IUD避孕效果好,脱环率较低,续用率高,不良反应少,安全,是妇女避孕较为理想的宫内节育器,值得基层计生服务中心推广应用。     

Phytostanol tablets reduce human LDL-cholesterol

The feasibility of using solid dosage forms containing stanol lecithin to lower human LDL-cholesterol was investigated. The particle size distribution of a coarse aqueous dispersion of a stanol lecithin mixture was determined at various weight ratios of the components. At a stanol-to-lecithin weight ratio of 1.00-1.50, dispersions could be spray dried and the solid reconstituted with water to produce a particle size distribution that was similar to that of the aqueous dispersion from which it was derived. Two solid dosage forms containing this spray-dried stanol lecithin preparation had different disintegration times--tablets less than 10 min and capsules greater than 45 min. Each delivery system was then tested for LDL-cholesterol reduction activity in a placebo-controlled, double-blind clinical trial containing a total of 52 subjects. After a six-week treatment period, the group that received rapidly disintegrating stanol lecithin tablets (1.26 g stanols daily) experienced a decrease in both LDL-cholesterol and the ratio of LDL-cholesterol to HDL-cholesterol by 10.4% (P = 0.01) and 11.5% (P = 0.03), respectively, relative to placebo. On the other hand, with slowly disintegrating capsules (1.01 g daily) there was no statistically significant difference in any lipid parameter between the active group and placebo group. Taken together, these studies demonstrate that for maximum LDL-cholesterol reduction activity the stanol lecithin formulation must be delivered in a rapidly dispersible form to reach the site of cholesterol absorption.     

Interactions of clonidine and nifedipine in moderately severe hypertensive patients

In ten patients (age: 47-59 yr) with moderately severe essential hypertension, the humoral and hemodynamic effects of a 4-day therapy with 2 x 75 micrograms clonidine, 2 x 20 mg nifedipine (slow-release), and their combination were investigated and compared with baseline values. The following measurements were observed under clonidine (C), nifedipine (N), and on combination (C/N), respectively: heart rate fell significantly under C from a mean of 79 to 67/min (P less than .05), increased to 73/min after N (P greater than .05) and fell again to 68/min under combination (P less than .05). Systolic blood pressure (Riva-Rocci method) decreased from a mean of 184 to 171 (C), 168 (N) and 161 mm Hg (C/N), respectively (P less than .01). Diastolic blood pressure was also significantly altered (113 vs. 104 (C), 107 (N), and 100 mm Hg (C/N); P less than .05). Stroke volume (ECHO) was not altered significantly (77 vs. 71 (C), 79 (N), and 80 mL (C/N), respectively), whereas cardiac output dropped from 5.9 to 4.9 L/min (C; P less than .05), increased to 5.7 (N; P greater than .05), and dropped again to 5.3 L/min (C/N; P greater than .05). Peripheral vascular resistance increased from a mean of 2091 to 2297 (C), fell to 1933 (N), and increased again to 2138 dyn/sec/cm-5 (C/N). Plasma norepinephrine levels fell from 440 to 281 (C; P less than .01), increased to 391 (N; P greater than .05), and fell again to 404 pg/mL (C/N; P greater than .05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of ethyl-2-(4-chlorophenyl)-5-ethoxy-4-oxazole acetate (Y-9738) on the serum lipids of patients with hyperlipidemia and/or hypo-HDL-emia

With the view of examining the serum lipid metabolism-improving action of a new compound, ethyl-2-(4-chlorophenyl)-5-ethoxy-4-oxazole acetate (Y-9738), 900 mg was administered to 47 patients with various diseases associated with hyperlipidemia and/or hypo-HDL (high density lipoprotein)-emia for successive 16 weeks. Serum HDL-cholesterol increased significantly 4 weeks after the administration (mean 11.8%, p less than 0.01). In the patients with hypo-HDL-emia who showed the initial level of 50 mg/dl or less, the degree of increase was more remarkable (mean 16,4%, p less than 0.01), and a significant increase was noted until 12 weeks later. Further, a similar change was noted in respect to serum HDL-phospholipid. The main apoprotein of HDL, apoprotein A (I + II) began to increase significantly 4 weeks after the institution of the administration. At the end of the trial, it increased by mean 31% (p less than 0.01). Y-9738 did not exert any significant effect on serum total cholesterol, triglyceride and phospholipid, but it caused a reduction in so-called atherogenic indexes.