Angiotensin-Converting Enzyme Inhibitors in Hypertension: To Use or Not to Use?

Most guidelines for the management of patients with cardiovascular disease recommend angiotensin-converting enzyme (ACE) inhibitors as first-choice therapy, whereas angiotensin receptor blockers (ARBs) are merely considered an alternative for ACE inhibitor–intolerant patients. The aim of this review was to compare outcomes and adverse events between ACE inhibitors and ARBs in patients. In patients with hypertension and hypertension with compelling indications, we found no difference in efficacy between ARBs and ACE inhibitors with regard to the surrogate endpoint of blood pressure and outcomes of all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. However, ACE inhibitors remain associated with cough and a very low risk of angioedema and fatalities. Overall withdrawal rates because of adverse events are lower with ARBs than with ACE inhibitors. Given the equal outcome efficacy but fewer adverse events with ARBs, risk-to-benefit analysis in aggregate indicates that at present there is little, if any, reason to use ACE inhibitors for the treatment of hypertension or its compelling indications.     

Genotoxic effects of aluminum chloride in cultured human lymphocytes treated in different phases of cell cycle.

Aluminum (Al) is the most abundant metal and the third common chemical element on earth. It is known that Al is toxic, especially its trivalent form (Al(3+)), that represents the its most soluble form. Al intoxication is related to some pathogenic disorders, principally neurodegeneratives ones as Parkinson and Alzheimer diseases. The present study aimed to evaluate the mutagenic potential of aluminum chloride (AlCl(3)). Comet assay and chromosome aberrations analysis were applied to evaluate the DNA-damaging and clastogenic effects of AlCl(3), respectively, in different phases of the cell cycle. Cultured human lymphocytes were treated with 5, 10, 15 and 25 microM aluminum chloride during the G1, G1/S, S (pulses of 1 and 6h), and G2 phases of the cell cycle. All tested concentrations were cytotoxic and reduced significantly the mitotic index in all phases of cell cycle. They also induced DNA damage and were clastogenic in all phases of cell cycle, specially in S phase. AlCl(3) also induced endoreduplication and polyploidy in treatments performed during G1 phase. The presence of genotoxicity and polyploidy on interphase and mitosis, respectively, suggests that aluminum chloride is clastogenic and indirectly affects the construction of mitotic fuse in all tested concentrations.     

Total deafness from aminoglycoside overdosage: histopathologic case study

A 57-year-old patient became totally deaf two days after receiving excessive doses of the aminoglycosidic antibiotic lividomycin parenterally for 14 days; she died four and a half months later. Her temporal bones were examined by microdissection, surface preparation, and serial sectioning of the modiolus. Loss of inner and outer cochlear hair cells was virtually complete. Refractile concretions were scattered along the atrophic stria vascularis, especially in the middle turn. The distal half of the radial cochlear nerve fibers in the osseous spiral lamina had degenerated, but closer to the modiolus they appeared to be intact. The spiral ganglion in the basal turn showed partial loss of neurons. Scanning electron microscopy revealed hair cell loss from the vestibular end-organs, more severe in the ampullar cristae than in the utricular macula. The dark cells of the utricular wall appeared to be altered.     

Genital warts and cervical cancer: II. Is human papillomavirus infection the trigger to cervical carcinogenesis?

Evidence of a biologically significant association between subclinical papillomavirus infection (SPI) and cervical neoplasia raises the question of whether this is a causal relationship. Human papillomavirus (HPV) infection of metaplastic epithelium in the cervical transformation zone is relatively common, producing latent infection in susceptible persons. The epidemiological characteristics of SPI and cervical cancer are essentially identical and there is a strong clinico-pathological association between condylomas and anogenital carcinoma. Tissue culture cells have been transformed from a normal to a neoplastic phenotype by animal papillomaviruses, and there is preliminary data reporting upon the successful identification of HPV genomic sequences in tumor cells. SPI commonly coexists with foci of cervical intraepithelial neoplasia (CIN). Areas of apparent transition are seen, and these two lesions are linked by a discernible spectrum of morphologic change. Such circumstantial evidence gives biological plausibility to the suggestion that HPV may be a cervical carcinogen. It is postulated that cervical neoplasia arises by progression from benign viral hyperplasia, through varying stages of koilocytotic atypia with associated dysplasia, to unremarkable carcinoma in situ. Invasion is presumed to reflect the emergence of an aggressive heteroploid clone, an age-related decline in host immune surveillance or an interaction of both factors.     

Systemic inflammation in unstable angina is the result of myocardial necrosis

OBJECTIVES: We investigated whether the source of the acute phase response in unstable angina (UA) lay within the culprit coronary plaque or distal myocardium. BACKGROUND: An inflammatory response is an important component of the acute coronary syndromes. However, its origin and mechanism remain unclear. METHODS: In 94 stable patients undergoing coronary angiography, the relationship between systemic levels of tumor necrosis factor (TNF)-alpha, interleukin-6 (IL-6) and C-reactive protein (CRP) and extent of atherosclerosis was studied. The temporal relationship between these markers and troponin T (TnT) was determined in 91 patients with UA. Cytokine levels were measured in the aortic root and coronary sinus of 36 unstable patients. RESULTS: There was no relationship found between stable coronary atherosclerosis and inflammatory marker levels. Compared with this group, admission levels of IL-6 (3.6 +/- 0.3 ng/ml vs. 10.7 +/- 1.7 ng/ml, p < 0.05) and CRP (2.3 +/- 0.1 mg/l vs. 4.6 +/- 0.6 mg/l, p < 0.05) were elevated in patients with UA. In this group, IL-6 and CRP remained elevated in those who subsequently experienced major adverse cardiac events. This inflammatory response occurred in parallel to the appearance of TnT. Both TNF-alpha (19.2 +/- 3.4 ng/ml vs. 17.1 +/- 3.3 ng/ml, p < 0.001) and IL-6 (10.3 +/- 1.4 ng/ml vs. 7.7 +/- 1.1 ng/ml, p < 0.01) were elevated in the coronary sinus compared with aortic root in patients with UA. This was principally observed in those who were TnT positive. There was no cytokine gradient across the culprit plaque. CONCLUSIONS: There is an intracardiac inflammatory response in UA that appears to be the result of low-grade myocardial necrosis. The ruptured plaque does not appear to contribute to the acute phase response.     

慢性细菌性前列腺炎病原学调查及药敏分析

对１３８例慢性细菌性前列腺炎患者的前列腺液进行细菌培养，其中１０７例培养阳性，分离出１０种１０７株病原菌。结果表明：革兰氏阳性球菌比例最大占６７．３％，其中金黄色葡萄球菌占４４．９％、居第１位，肠球菌占１４％居第２位。革兰氏阴性杆菌以大肠埃希氏菌（１１．２％）和肺炎克雷伯氏菌（７．５％）分离率最高。此外，淋球菌（４．７％）和白色念珠菌（３．７％）均有检出。对１０３株细菌用８种常用抗菌药物作体外药物敏感试验，发现细菌对氟啶酸敏感率最高，其次为氟哌酸和先锋５号，而壮观霉素对淋球菌抑菌力最强。     

Cardiovascular consequences of expressing anger in a mutually-dependent relationship

Twenty males were harrassed by a confederate of the experimenters while solving anagrams. Following this experience they played a mixed-motive, interpersonal game with the confederate. In comparison with non-harrassed controls the harrassed subjects expressed more anger at the end of the task. While solving anagrams they also exhibited greater increases in systolic blood pressure and heart rate and greater decreases in finger pulse amplitude and pulse wave transit time. The post- harrassment adjustment of cardiovascular behavior during the interpersonal games was contingent upon the subject's aggression guilt, level of exploitativeness, and uncertainty concerning the consequences of exploiting the confederate. The greater the subject's aggression guilt the less anger he expressed at the end of the anagrams task and the less he exploited the confederate. The more a subject exploited the confederate the lower his diastolic blood pressure at the end of the game. The greater the uncertainty of consequences of behavior the faster the transmission of pulses and the smaller the drop in blood pressure during the game. The potential utility of interpersonal games for studying behavioral and biological adjustments during post-anger interpersonal transactions in a mutually-dependent relationship is illustrated.