RAAS polymorphisms alter the acute blood pressure response to aerobic exercise among men with hypertension

Limited evidence suggests renin–angiotensin–aldosterone system (RAAS) polymorphisms alter the blood pressure (BP) response to aerobic exercise training. We examined if RAAS polymorphisms influenced postexercise hypotension in men with high normal to Stage 1 hypertension. Forty-seven men (44.2±1.4 years, 145.1±1.6/85.5±1.1 mmHg) randomly completed three experiments: seated rest (control) and two cycle exercise bouts at 40% (LITE) and 60% (MOD) of maximal oxygen consumption. Ambulating BP was measured for 14 h after each experiment. RAAS polymorphisms associated with hypertension (i.e. angiotensin converting I enzyme, ACE I/D; angiotensin II type 1 receptor, AT₁R A/C; and intron 2 of aldosterone synthase, Int2 W/C) were analyzed using polymerase chain reaction and restriction enzyme digestion. Repeated measure ANOVA tested if BP differed between experimental conditions by RAAS genotypes. Compared to men with 0–2 variant alleles, men with ≥3 combined RAAS variant alleles had lower average systolic BP (SBP) (P=0.030) and lower average diastolic BP (DBP) (P=0.009) for 14 h only after LITE. In contrast, average BP was not different for MOD and control between RAAS variant allele groups over this time period (P≥0.05). LITE reduced BP in men with ≥3 variant RAAS alleles for 14 h, whereas MOD had no influence on BP in these men. In order to optimally prescribe exercise for its BP lowering benefits in those with hypertension, additional knowledge of how genetic variation affects the BP response to exercise is needed.Sources of Support: Supported by an American Heart Association Grant-in-Aid # 0150507N     

Influence of emotional content and context on memory in mild Alzheimer's disease

Healthy subjects remember emotional stimuli better than neutral, as well as stimuli embedded in an emotional context. This better memory of emotional messages is linked to an amygdalo-hippocampal cooperation taking place in a larger fronto-temporal network particularly sensitive to pathological aging. Amygdala is mainly involved in gist memory of emotional messages. Whether emotional content or context enhances memory in mild Alzheimer's disease (AD) patients is still debated. The aim of the present study is to examine the influence of emotional content and emotional context on the memory in mild AD, and whether this influence is linked to amygdala volume. Fifteen patients affected by mild AD and 15 age-matched controls were submitted to series of negative, positive, and neutral pictures. Each series was embedded in an emotional or neutral sound context. At the end of each series, participants had to freely recall pictures, and answer questions about each picture. Amygdala volumes were measured on patient 3D-MRI scans. In the present study, emotional content significantly favored memory of gist but not of details in healthy elderly and in AD patients. Patients' amygdala volume was positively correlated to emotional content memory effect, implying a reduced memory benefit from emotional content when amygdala was atrophied. A positive context enhanced memory of pictures in healthy elderly, but not in AD, corroborating early fronto-temporal dysfunction and early working memory limitation in this disease.     

Laparoscopic Management of an Intrauterine Fallopian Tube Incarceration After Curettage for a Non-progressing Pregnancy

Study ObjectiveTo report and demonstrate a case of a laparoscopic repair of an intrauterine fallopian tube incarceration as complication of curettage.DesignA step-by-step explanation of the surgery using video (instructive video) (Canadian Task Force classification III).SettingUniversity Hospital Estaing, Clermont-Ferrand, France.PatientA 29-year-old woman experiencing a nonevolving pregnancy at 8 weeks underwent curettage. After 9 months, she complained of abnormal vaginal discharge. Ultrasound evaluation showed a right parauterine mass. She reported a maternal medical history of ovarian cancer in a context of Lynch syndrome. Magnetic resonance imaging revealed a right hydrosalpinx 12 mm in diameter, with a suspect fimbriae lesion of the tube and a 7-mm endometriosis nodule of the uterine torus.InterventionWe decided to explore the fallopian tube by laparoscopy and to perform hysteroscopy. A fallopian tube incarceration was suspected during hysteroscopy: a defect of the uterine wall was observed, through which there was protrusion of a tubal fimbriae. The laparoscopic view of the pelvis confirmed incarceration of the right fallopian tube through the uterine wall. It was carefully extracted out of the uterine defect, and the uterine wall defect was repaired with an X-point using Monocryl 1.Measurements and Main ResultsA tubal patency test was performed, which was positive on both sides. Because phimosis responsible for the hydrosalpinx had been treated, salpingectomy was not performed.ConclusionCurettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.     

Efficacy and safety of nivolumab in patients with non-small cell lung cancer: a retrospective study in clinical practice

Nivolumab, a fully human immunoglobulin monoclonal antibody inhibiting the programmed cell death protein‐1 receptor, demonstrated robust efficacy and a manageable safety profile across multiple tumor types in clinical trials. The aim of the present study was to investigate the efficacy and safety of nivolumab for pretreated patients with non-small cell lung cancers in clinical practice. In this observational monocentric retrospective study, 98 patients were enrolled between February 2015 and February 2016. The global median overall survival was 6.34 months (95% confidence interval (CI) : 4.11–10.88) and the global median progression free survival was 1.84 months (95% CI: 1.68–2.73). In the univariate analysis, clinical performance status score was the only factor significantly correlated with overall survival. The safety profile of nivolumab is consistent with that described in prior studies, with only 7% undesirable effects requiring the discontinuation of treatment. The results of the present study demonstrate that nivolumab affords clinical efficacy and manageable tolerability in patients with non-small cell lung cancers.     

Selection of an immunoassay screening cutoff concentration for opioids in oral fluid

A retrospective analysis of data from oral fluid specimens was conducted in order to identify a relevant cutoff concentration for opiates and/or synthetic opiates in oral fluid. Previously proposed regulations from the Substance Abuse and Mental Health Services Administration (SAMHSA) have recommended 40 μg/L as a cutoff concentration. In this study, data from oral fluid specimens collected using the Quantisal? device and screened with enzyme linked immunosorbent assays (ELISA) for both opiates and oxycodone were retrospectively assessed for screen positives > 20 μg/L and those between negative and 20 μg/L. Specimens identified at these concentrations were then analyzed using liquid chromatography with tandem mass spectral detection using a fully validated procedure. Overall, 156 positive specimens were identified using 40 μg/L; 191 specimens using 20 μg/L; and 241 specimens between negative and 20 μg/L. Specifically, the number of 6-acetylmorphine (6-AM) positives increased from 10 to 16; morphine 4 to 9; codeine from 11 to 19; oxycodone from 56 to 74; hydrocodone from 73 to 119; and hydromorphone from 2 to 4 when specimens with enzyme inhibition between negative and 20 μg/L were analyzed. For workplace testing where only codeine, morphine, and 6-AM are considered, the use of a lowered cutoff concentration produced significant increases in the positive rate.     

The prognostic value of erythrocyte polyamines in the preoperative evaluation of patients with renal cell carcinoma

IntroductionPolyamines, spermine and spermidine, are ubiquitous polycationic structures, which are essential for cell proliferation and differentiation. We tested whether spermine and spermidine could improve the prognostic ability of six established preoperative predictors of cancer-specific mortality (CSM) after partial or radical nephrectomy for renal cell carcinoma (RCC).Materials and methodsOverall, 385 patients with clinical stages T_1–3, M_0–1 RCC were treated with radical or partial nephrectomy at a single institution between 1990 and 2007. Kaplan–Meier plots depicted CSM after stratification according to spermine and spermidine levels (dichotomised to above and below the median value). Univariable and multivariable Cox regression models tested the prognostic ability of continuously coded spermine and spermidine levels in preoperative CSM predictions. Covariates consisted of pre-treatment T stage, M stage, age, gender and symptom classification.ResultsThe 5-year CSM-free survival of patients with spermine levels ?4.5 and >4.5 nmol/8 × 10⁹ erythrocytes were, respectively, 79.5% and 65.0%. Similarly, the 5-year CSM-free survival of patients with spermidine levels ?9.0 and > 9.0 nmol/8 × 10⁹ erythrocytes were, respectively, 81.1% and 63.7%. In multivariable analyses addressing CSM after surgery, both spermine (p ? 0.002) and spermidine (p ? 0.001) achieved independent predictor status and improved the accuracy of established preoperative CSM predictors by 2.1% (p < 0.001).ConclusionsCirculating polyamine levels may significantly improve the prognostic value of established determinants of CSM in patients with RCC of all stages prior to nephrectomy. External validation of our findings is required prior to implementation in clinical practice.