Acute hemodynamic effects of combined inhibition of neutral endopeptidase and angiotensin converting enzyme in spontaneously hypertensive rats

Summary— Neutral endopeptidase inhibitors (NEPI) potentiate the hypotensive effect of converting enzyme inhibitors (CEI) in conscious spontaneously hypertensive rats (SHR) but the mechanism of this potentiation remains unknown. The present study assesses the hemodynamic effects of a CEI (enalaprilat 1 mg/kg; n = 9), a NEPI (retrothiorphan 25 mg/kg + 25 mg/kg/h; n = 9) and the combination (CEI + NEPI; n = 9) versus a control group ( n = 9) in anesthetized spontaneously hypertensive rats. CEI alone induced a significant hypotensive effect due to a decrease (–35.1%) in total peripheral resistance (TPR), with no significant increase in cardiac output (CO). NEPI alone had a slight hypotensive effect due to a small decrease in CO. CEI + NEPI decreased the mean arterial pressure to the same extent (–26.7%) as the CEI-induced hypotensive effect, decreased TPR (–44.4%) and induced an increase in CO (+ 38.2%) with an increase in heart rate. In summary, NEPI combined with CEI induces large decreases in blood pressure and in TPR which do not significantly differ from the CEI-induced effects. It also induces increases in heart rate and in cardiac output in anesthetized SHR.     

Whiplash injury of the cervical spine--initial evaluation and treatment of late sequelae

Principal requirement for adequate management of whiplash patients is considerable familiarity with symptoms of whiplash injury and knowledge of risk factors contributing to delayed recovery. In addition, evidence based knowledge of treatment strategies may help promoting an integrative initial assessment leading to therapy which likely may prevent chronicity.     

Diatrizoate enemas: facts and fallacies of colonic toxicity

Rats were given enemas of Gastrografin in two strengths, Renografin--76, and Tween--80 in a 10% dilution. There were no deleterious effects on the colons with these media used in volumes to fill the colon. Severe changes resulted from volumes which produced overdistention.     

Workplace conditions predict the risk of premature death and functional dependence after retirement—results of a gerontological follow-up study in Germany

Between 1983 and 1985, 595 employees who were entering retirement in East Germany were given a medical examination and asked to assess their workplace conditions. Ten years later, we examined whether occupational predictors were associated with death and functional dependence among the study participants and assessed how the surviving pensioners coped with activities and instrumental activities of daily living. We assigned the occupational factors reported between 1983 and 1985 to two scales: demands and resources. Multiple logistic regression analyses were carried out to examine the association of occupational and medical predictors with the outcome variables death and functional dependence. Workplace resources but not demands were significantly associated with a reduced chance of death in women, independent of medical diagnoses. For men neither of these associations were verified. Concerning functional dependence individual items such as ‘control over work content’ (for both sexes) significantly reduced the risk of developing ADL-dependence. The associations remained stable after medical diagnoses were additionally taken into consideration. The results of our study highlight the influence of occupational factors beyond working life and support the importance of starting geriatric health promotion before retirement age. Public Health (2001) 115, 345–349.     

Author’s reply

European Spine Journal -     

Effects of music therapy on depression compared with psychotherapy

This paper reports a study testing the effects of music on depression and compares them with the effects of psychotherapy. There are mainly three conventional treatments for depression: psychotherapy, pharmaceutical treatments, and electroconvulsive therapy. Because conventional treatment has proven to be poorly successful, new means of treatment must be found that might improve depression when used together with other therapies. A randomized controlled clinical trial was performed with a convenience sample of 79 patients aged 25–60 years with low- and medium-grade depression. The Zung Depression Scale was employed for selection purposes. Patients were randomly assigned to the music-therapy group (classical and baroque music) (n = 41), or the psychotherapy group based on conductive-behavioral therapy (n = 38). The music therapy was applied for 50 min a day, every day, for eight weeks. At the end, the music-therapy group had less depressive symptoms than the psychotherapy group, and this was proven to be statistically significant with the Friedman test. We propose that patients with low- and medium-grade depression can use music to enhance the effects of psychological support.     

ADOPTION OF MELD SCORE INCREASES THE NUMBER OF LIVER TRANSPLANT

Background

Liver transplantation is performed at large transplant centers worldwide as a therapeutic intervention for patients with end-stage liver diseases.

Aim

To analyze the outcomes and incidence of liver transplantation performed at the University of São Paulo and to compare those with the State of São Paulo before and after adoption of the Model for End-Stage Liver Disease (MELD) score.

Method

Evaluation of the number of liver transplantations before and after adoption of the MELD score. Mean values and standard deviations were used to analyze normally distributed variables. The incidence results were compared with those of the State of São Paulo.

Results

There was a high prevalence of male patients, with a predominance of middle-aged. The main indication for liver transplantation was hepatitis C cirrhosis. The mean and median survival rates and overall survival over ten and five years were similar between the groups (p>0.05). The MELD score increased over the course of the study period for patients who underwent liver transplantation (p>0.05). There were an increased number of liver transplants after adoption of the MELD score at this institution and in the State of São Paulo (p<0.001).

Conclusion

The adoption of the MELD score led to increase the number of liver transplants performed in São Paulo.