Relationship between ambulatory blood pressure monitoring values and future occurrence of ischemic cerebrovascular and coronary events in hypertensive patients.

OBJECTIVES: To evaluate in a prospective study the relationship between 24-hour ambulatory blood pressure monitoring (ABPM) values and the occurrence of nonfatal ischemic cerebrovascular and coronary events in treated hypertensive patients. METHODS: Out of 8780 ABPM recordings we identified 79 hypertensive patients (both genders) who suffered a first nonfatal ischemic event, either cerebrovascular (stroke or transient ischemic attack) (STR/TIA, n = 48) or coronary (myocardial infarction, angina or coronary bypass/PTCA) (COR, n = 31) and 223 control-hypertensive patients (CTR) without any events during the same period who were fully matched (at the time of ABPM) for age, gender, antihypertensive therapy, presence of dyslipidemia or diabetes, and casual blood pressure (BP), in the proportion of 1 STR/TIA to 3 CTR and 1 COR to 6 CTR. Matched groups were compared for various ABPM parameters. RESULTS: On average, the time between ABPM and the occurrence of STR/TIA and COR events was respectively 32.4 (1 to 88) and 28.0 (1 to 73) months. For similar values of matched variables significant differences (p < 0.05) were observed between STR/TIA vs. CTR in 24-hour systolic BP (147.4 +/- 20.6 vs. 140.1 +/- 14.9 mmHg), daytime systolic BP (151.6 +/- 21.8 vs. 144.6 +/- 15.2 mmHg) and nighttime systolic BP (138.5 +/- 21.2 vs. 130.9 +/- 16.0 mmHg), and between COR vs. CTR in 24-hour systolic BP (143.5 +/- 19.5 vs. 135.2 +/- 15.6 mmHg), daytime systolic BP (146.3 +/- 20.5 vs. 139.6 +/- 15.9 mmHg) and nighttime systolic BP (138.1 +/- 19.7 vs. 126.2 +/- 16.4 mmHg), BP on rising (146.2 +/- 31.7 vs. 133.6 +/- 19.9 mmHg) and blunted nighttime BP dipping (5.3 +/- 7.4 vs. 9.60 +/- 6.0%). Versus CTR, STR/TIA showed a lower percentage of dippers (27.7 vs. 44.4%) and a higher percentage of extreme dippers (10.6 vs. 6.3%), nondippers (48.9 vs. 41.7%) and inverted dippers (12.8 vs. 7.6%). Versus CTR, the COR group showed (p < 0.02) a lower percentage of dippers (21.9 vs. 46.8%) and extreme dippers (3.1 vs. 4.3%) and a higher percentage of nondippers (56.3 vs. 43.0%) and inverted dippers (18.8 vs. 5.9%). CONCLUSIONS: This prospective study in treated hypertensive patients shows that both high ABPM values and abnormal daytime/nighttime BP profiles are associated with later occurrence of ischemic cerebrovascular and coronary events independently of casual BP values and other cardiovascular risk factors. This reinforces the idea that ABPM is a powerful predictor of future cardiovascular events.     

Relationship of circadian blood pressure and morning blood pressure surge with the severity of metabolic syndrome in newly diagnosed hypertensives.

OBJECTIVES: Twenty-four-hour ambulatory blood pressure (BP) data and the presence of metabolic syndrome (MS) are both good discriminators of cardiovascular risk. We examined the relationship between metabolic syndrome scores as defined by the International Diabetes Federation 2005 report (IDF-2005) and 24h ambulatory BP data in newly diagnosed hypertensives. METHODS: We evaluated 352 non-diabetic subjects (male/female: 167/185, aged 49+/-13). Based on IDF-2005 criteria, 212 subjects fulfilled 0, 1 or 2 criteria (no metabolic syndrome) and 140 fulfilled 3, 4 or 5 criteria (metabolic syndrome). Patients were divided into two groups (MS and non-MS), matched for age and casual BP All underwent 24h ambulatory blood pressure monitoring. RESULTS: No significant differences were found between non-MS and MS for casual BP (153/92+/-17/8 vs. 154/92+/-16/8 mmHg), age (48+/-14 vs. 50+/-12 years), 24h ambulatory BP (131/82+/-14/10 vs. 133/82+/-14/9 mmHg), daytime BP (135/86+/-14/11 vs. 137/85+/-14/9 mmHg), nighttime BP (122/74+/-15/11 vs. 124/74+/-15/10 mmHg), nighttime fall (9+/-6 vs. 9+/-6 %), BP on arising (131/82+/-20/15 vs. 135/82+/-21/15 mmHg), evening surge (7+/-14 vs. 10+/-15 mmHg), percentage of dippers (42.5 vs. 37.1%) or percentage of non-dippers (50.9 vs. 50.7%). However, significant differences between non-MS and MS were found for morning BP surge (25+/-12 vs. 28+/-15 mmHg, p<0.03). Also, when patients were divided into four groups according to MS scores (0/1, 2, 3 or 4/5), significant differences between groups were observed only for BP on arising (group 2 vs. 4/5, 132/79+/-21/15 vs. 140/84+/-10/15 mmHg, p<0.05; group 3 vs. 4/5, 131/81+/-20/15 vs. 140/84+/-20/15, p<0.005) and for morning BP surge (group 0/1 vs. 4/5, 24+/-11 vs. 29+/-15 mmHg, p<0.003). CONCLUSIONS: We conclude that in newly diagnosed hypertensive subjects there is no significant relationship between the severity of metabolic syndrome and ambulatory blood pressure data or circadian variations. The only exception found was a greater morning BP surge in patients with MS, whose importance as a determinant of cardiovascular risk needs to be clarified by further studies.     

Reversal of Profound Rocuronium Neuromuscular Blockade by Sugammadex in Anesthetized Rhesus Monkeys

Background: Reversal of neuromuscular blockade can be accomplished by chemical encapsulation of rocuronium by sugammadex, a synthetic [gamma]-cyclodextrin derivative. The current study determined the feasibility of reversal of rocuronium-induced profound neuromuscular blockade with sugammadex in the anesthetized rhesus monkey using train-of-four stimulation.

Methods: Four female rhesus monkeys each underwent three experiments. In each experiment, first, a 100-[mu]g/kg dose of rocuronium was injected and spontaneous recovery was monitored. After full recovery, a 500-[mu]g/kg dose of rocuronium was injected. Up to this point, all three experiments in a single monkey were identical. One minute after this rocuronium injection, either one of the two tested dosages of sugammadex (1.0 or 2.5 mg/kg) was injected or saline was injected.

Results: Injection of 100 [mu]g/kg rocuronium resulted in a mean neuromuscular blockade of 93.0% (SD = 4%), and profound blockade was achieved by injection of 500 [mu]g/kg. In all experiments, a 100% neuromuscular blockade was achieved at this dose. After injection of the high rocuronium dose, the 90% recovery of the train-of-four ratio took 28 min (SD = 7 min) after saline, 26 min (SD = 9.5 min) after 1 mg/kg sugammadex, and 8 min (SD = 3.6 min) after 2.5 mg/kg sugammadex. Signs of residual blockade or recurarization were not observed. Injection of sugammadex had no significant effects on blood pressure or heart rate.     

Indikation und Ergebnisse nach Radiuskopfprothesen

Treatment of unreconstructible comminuted fractures of the radial head (Mason type III or IV) remains controversial. Radial head excision was advocated for the management of these severe fractures in the past. Complications such as valgus elbow instability, elbow stiffness, and proximal radial migration can be the result. There is limited information on the outcome of arthroplasty with a radial head implant. The functional outcomes of 19 patients with arthroplasty of the radial head were evaluated after an average of 40.4 months. According to the functional rating index (Broberg and Morrey), 2 results were graded as poor, 6 as fair, and 11 as good or excellent. The poor and fair outcomes were associated with concomitant injuries. Elbow flexion of the injured extremity averaged 121±15°, extension ?19±12°, pronation 76±17°, and supination 73±18°. Valgus stability was restored and proximal radial migration did not occur. Complications included two luxations, but no wound infection. Patients treated with radial head prosthesis for a severely comminuted radial head fracture have mild to moderate impairment of the elbow and wrist. Arthroplasty with a radial head prosthesis was found to have been a safe and effective treatment option.     

Schizophrenia as a progressive brain disease.

There is convincing evidence that schizophrenia is characterized by abnormalities in brain volume. At the Department of Psychiatry of the University Medical Centre Utrecht, Netherlands, we have been carrying out neuroimaging studies in schizophrenia since 1995. We focused our research on three main questions. First, are brain volume abnormalities static or progressive in nature? Secondly, can brain volume abnormalities in schizophrenia be explained (in part) by genetic influences? Finally, what environmental factors are associated with the brain volume abnormalities in schizophrenia? Based on our findings we suggest that schizophrenia is a progressive brain disease. We showed different age-related trajectories of brain tissue loss suggesting that brain maturation that occurs in the third and fourth decade of life is abnormal in schizophrenia. Moreover, brain volume has been shown to be a useful phenotype for studying schizophrenia. Brain volume is highly heritable and twin and family studies show that unaffected relatives show abnormalities that are similar, but usually present to a lesser extent, to those found in the patients. However, also environmental factors play a role. Medication intake is indeed a confounding factor when interpreting brain volume (change) abnormalities, while independent of antipsychotic medication intake brain volume abnormalities appear influenced by the outcome of the illness. In conclusion, schizophrenia can be considered as a progressive brain disease with brain volume abnormalities that are for a large part influenced by genetic factors. Whether the progressive volume change is also mediated by genes awaits the results of longitudinal twin analyses. One of the main challenges for the coming years, however, will be the search for gene-by-environment interactions on the progressive brain changes in schizophrenia.     

Effect of oral sustained-release nitroglycerin on exercise capacity in angina pectoris: Dose-response relation and duration of action during double-blind crossover randomized acute therapy

Ten men with documented coronary artery disease and stable exertional angina underwent a doubleblind crossover study to examine the benefit and the duration of action on their symptom-limited exercise capacity of 2 doses (2.5 and 6.5 mg) of sustainedrelease nitroglycerin (SRNG). A multistage bicycle test was performed in the sitting position by steps of 30 W each 3 minutes until the onset of typical angina pectoris. It was performed 24 hours before the start of the study; 1 and 5 hours after administration of placebo, and repeated after 2.5 and 6.5 mg of SRNG administered in a double-blind crossover study according to a 4 successive days protocol. No differences appeared between administration of placebo (1 and 5 hours) and the results obtained at the first exercise test. The dose of 2.5 mg of SRNG was effective on the symptom-limited working capacity but only at 1 hour (+9%; p < 0.01). The dose of 6.5 mg was more effective both at 1 hour (+25%; p < 0.001) and at 5 hours (+27%; p < 0.001). All patients had angina at a higher heart rate (+5 to 8%; p = NS [not significant] and p < 0.01), whereas systolic blood pressure and double product tended to be slightly but insignificantly increased. S-T depression at the onset of angina was insignificantly changed with placebo, and 2.5 and 6.5 mg of SRNG. It is concluded that 6.5 mg of orally administered SRNG is effective during at least 5 hours, and that the magnitude of the benefit and its duration are dose-related.     

Selective brain regional changes in lipid profile with human aging

GeroScience - Fatty acids are key components in the structural diversity of lipids and play a strategic role in the functional properties of lipids which determine the integrity of neuronal and...