Chronotherapy of Hypertension with Angiotensin Receptor Blockers–A Meta-Analysis of Blood Pressure Measured by Ambulatory Blood Pressure Monitoring in Randomized Trials

BackgroundWe performed this meta-analysis evaluating the efficacy of chronotherapy of hypertension with angiotensin receptor blockers (ARBs).MethodsWe searched Pubmed, Web of Science, and Cochrane for all published randomized trials that compare antihypertensive effects of ARBs between bedtime dosing and awakening dosing. Blood pressure (BP) was measured by ambulatory BP monitoring in patients with mild or moderate essential hypertension.ResultsThe effects of ARBs on BP were assessed in 805 essential hypertensive patients included in 8 trials with a follow-up of 12 ± 3 weeks. The sleep-time systolic and diastolic BP (SBP, DBP) with bedtime dosing greatly decreased as compared with awakening dosing (weighted mean differences [WMD] for SBP WMD ?5.23 [95% confidence intervals (CI), ?7.27, ?3.20] mm Hg, p < 0.001; WMD for DBP ?2.94 [95% CI, ?4.52, ?1.36] mm Hg, p < 0.001). The reduction of daytime SBP (WMD 0.98 [95% CI, ?0.20, 2.17] mm Hg, p = 0.10), DBP (WMD 0.11 [95% CI, ?0.68, 0.89] mm Hg, p = 0.79), 24 hour SBP (WMD ?0.75 [95% CI, ?1.93, 0.42] mm Hg, p = 0.21) and DBP (WMD ?0. 77 [95% CI, ?1.55 0.01] mm Hg, p = 0.05) with bedtime dosing was similar with awakening dosing.ConclusionsBedtime dosing with ARBs is more effective in lowering sleep-time BP than awakening dosing in patients with essential hypertension, suggesting a utilization of chronotherapy of hypertension with ARBs to reduce sleep-time high BP. Larger multi-ethnic studies are needed to investigate the efficacy of chronotherapy of hypertension.     

Switching antipsychotic medication to aripiprazole: position paper by a panel of Italian psychiatrists

Introduction: Patients with schizophrenia or bipolar disorder treated with antipsychotic medication can frequently experience lack of efficacy and persistent side-effects, so much so that switching from one antipsychotic to another with a different side-effect profile has become a recommended strategy for improving the tolerability and safety of long-term antipsychotic treatment. Aripiprazole is an atypical antipsychotic with proven efficacy in schizophrenia and bipolar I disorder, with a pharmacological profile distinct from other available antipsychotics and a side-effect profile that is different from other agents in the class; these characteristics make it a possible alternative in patients requiring a change in antipsychotic treatment due to lack of efficacy or persistent side-effects.

Areas covered: A panel of Italian experts in psychiatry met to discuss the appropriateness of current strategies for the switch to aripiprazole in patients with schizophrenia or bipolar disorder once a clinician has decided to adopt this choice and also to propose alternate strategies where required. The strategies for the switch to aripiprazole presented in this position paper consider various scenarios encountered in clinical practice, highlight the importance of tapering the prior antipsychotic based on its pharmacological characteristics and provide detailed guidance throughout the entire switching process. Literature searches were conducted using the PubMed database and the search strategy (aripiprazole and switching); additional references were added from the reference lists of the papers obtained and also from the authors’ knowledge of the topic.

Expert opinion: Few studies have addressed the indications for antipsychotic switching and the best practical strategies to achieve the desired goal in the clinical practice setting. Studies on antipsychotic switching should clarify why, when and how a switch should be done. The results should standardize the reasons for switching an antipsychotic, assess the optimal time to switch and evaluate the best ways to switch. Both clinical and pharmacological factors should be considered when a patient needs to switch antipsychotics, and specific guidelines for antipsychotic switching that address all these factors are needed.     

Genotoxic and oxidative responses in coelomocytes of Eisenia fetida and Hediste diversicolor exposed to lipid‐coated CdSe/ZnS quantum dots and CdCl2

The emerging of Quantum Dots utilization in industrial or medicinal fields involved a potentially increase of these nanoparticles in environment. In this work, the genotoxic (comet assay) and oxidative effects (SOD activity, TBARS) of functionalized‐QDs and cadmium chloride were investigated on Hediste diversicolor and Eisenia fetida coelomocytes. Results demonstrated that functionalized‐QDs (QDNs) and cadmium chloride induced DNA damages through different mechanisms that depended on the nano‐ or ionic nature of Cd. The minimal genotoxic concentrations for H. diversicolor (<0.001ng/g for QDNs and CdCl₂) were lower than for E. fetida (between 0.01 and 0.1 ng/g for QDNs, and between 0.001 and 0.01 ng/g for CdCl₂). These results showed that H. diversicolor was more sensitive than E. fetida. The two contaminants had a low impact on the oxidative stress markers. © 2014 Wiley Periodicals, Inc. Environ Toxicol 30: 918–926, 2015.     

Mesenteric Cyst with GI Symptoms: A Fluid Approach to Treatment—Case Report and Literature Review

Digestive Diseases and Sciences - Mesenteric cysts are defined as a heterogeneous group of intra-abdominal cystic lesions of the mesentery or omentum that may be found in any portion of the...     

紫杉醇联合替吉奥胶囊治疗晚期食管癌的临床疗效观察

目的观察紫杉醇联合替吉奥胶囊治疗晚期食管癌的临床疗效和不良反应。方法选择37例晚期食管癌患者,予紫杉醇175 mg/m2,d1,静脉滴注3 h;替吉奥胶囊服用剂量按体表面积<1.25 m2者剂量40毫克/次;体表面积1.25~1.5 m2者剂量50毫克/次;体表面积>1.5 m2者剂量60毫克/次;均每日2次,早晚餐后口服,连服14 d,21 d为1个周期。结果疗效可评价患者36例,其中完全缓解(CR)1例,部分缓解(PR)14例,病情稳定(SD)11例,病情进展(PD)10例,有效率(CR+PR)为41.7%;疾病控制率(CR+PR+SD)为72.2%;中位疾病进展时间(m TTP)及中位生存时间分别为7.4个月、10.6个月,1年生存率为36.1%。化疗的主要不良反应为脱发及骨髓抑制,其中Ⅲ~Ⅳ度中性粒细胞减少发生率为16.7%。结论紫杉醇联合替吉奥胶囊治疗晚期食管癌疗效肯定,且耐受性较好。     

Osteitis condensans ilii: prevalence and characteristics of a neglected mimic of sacroiliitis

Clinical Rheumatology - Osteitis condensans ilii (OCI) is a benign condition characterised by triangular sclerosis of the iliac bone which may mimic radiographic sacroiliitis. Prevalence is...     

Chronic Oral Anticoagulation and Clinical Outcome in Hospitalized COVID-19 Patients

Cardiovascular Drugs and Therapy - The clinical course of COVID-19 may be complicated by acute respiratory distress syndrome (ARDS) and thromboembolic events, which are associated with high risk of...     

IL-1β对脓毒症新生幼鼠胼胝体内少突胶质细胞前体细胞分化成熟的影响

目的:探讨IL-1β对少突胶质细胞前体细胞(OPCs)分化成熟及轴突髓鞘化的影响。方法:将出生1 d的SD幼鼠96只随机分为2组:对照组和脂多糖(LPS)组各48只。LPS组给予腹腔注射1mg/kg LPS,对照组腹腔注射等体积PBS。根据注射后时间分为3 h、24 h、3 d、7 d、14 d、28 d 6个亚组,应用双标免疫组化及Western blotting的方法观察3 h、24 h、3 d、7 d时IL-1β及IL-1受体1(IL-1R1)的表达和14 d、28 d时髓鞘碱性蛋白(MBP)的表达。进行原代OPCs培养将其分为对照组、IL-1β组、IL-1β+IL-1受体拮抗剂(IL-1Ra)组及IL-1Ra组。将其诱导分化3 d后利用免疫荧光及Western blotting比较4组间MBP的表达。结果:与对照组相比,LPS注射后3 h、24h、3 d、7 d幼鼠胼胝体小胶质细胞表达IL-1β明显增加,其受体在OPCs表达增加。LPS注射后14 d、28 d,MBP在胼胝体的表达下降。细胞实验显示原代OPCs培养诱导分化3 d后IL-1β可以抑制MBP的表达,并且可以被IL-1Ra逆转。IL-1β可抑制磷酸化ERK的表达,ERK过表达可逆转IL-1β对MBP的抑制作用。结论:在脓毒症新生幼鼠胼胝体内IL-1β有可能通过抑制ERK通路来抑制OPCs成熟,从而导致脑白质轴突低髓鞘化。