Cardiac structural and functional changes during long-term antihypertensive treatment with lacidipine and atenolol in the European Lacidipine Study on Atherosclerosis (ELSA)

OBJECTIVES: To evaluate and correlate the effects of long-term antihypertensive treatment on left ventricular (LV) mass and carotid structural changes in a large group of essential hypertensive patients, participating in the European Lacidipine Study on Atherosclerosis (ELSA). DESIGN: In four (Brescia, Glasgow, Naples and Pisa) of 23 centres participating in the ELSA study, an echocardiographic examination was performed at baseline and repeated, until the end of the 4-year study, in essential hypertensive patients, followed-up for carotid quantitative ultrasound examination of intima-media thickness (IMT), after random allocation to treatment with either lacidipine or atenolol (and added hydrochlorothiazide, as required for control of blood pressure). METHODS: M-mode, two-dimensional guided echocardiography was used to measure left ventricular (LV) wall thickness and dimensions, from which LV mass was calculated, using an anatomically validated formula (Penn Convention) and indexed to body surface area (left ventricular mass index, LVMI). The echocardiographic tracings were blindly evaluated in a single reading centre (Brescia). Bilateral IMT was measured at the site of common carotid and bifurcation far walls (CBMmax). RESULTS: At baseline, cardiac and carotid ultrasound scans were available in 278 patients (mean age 54 +/- 7 years, 57% males, 22% obese). A significant correlation was observed between baseline LVMI and CBMmax (r = 0.22, P < 0.001), independent of age. In multivariate analysis, CBMmax and mean 24-h pulse pressure were most strongly associated with baseline LVMI. A significant reduction in LVMI was observed both during lacidipine (n = 96) (-12.5% reduction) and atenolol (n = 78) (-13.9% reduction) treatments (up to 4 years) (P < 0.001 for both, without significant differences between treatments). Changes in LVMI were not related to changes in carotid wall thickness. In multivariate analysis, baseline LV mass and mean 24-h systolic blood pressure changes were significantly associated with changes in LV mass. CONCLUSIONS: In this large, long-term controlled study, antihypertensive treatment with atenolol or lacidipine was accompanied by a similar and significant decrease in LV mass. Treatment-induced changes in LV mass were related to baseline LV mass and changes in 24-h mean systolic blood pressure, without any correlation with changes in carotid structure. In the whole ELSA population, carotid IMT changes have been shown to be unrelated to blood pressure reduction, but significantly influenced by the type of antihypertensive treatment.     

Childhood Loss in Alcoholics and Narcotic Addicts

Parental loss in childhood is more common in alcoholics and narcotic addicts than normal controls. These differences are not confounded by demographic variables or depression. The loss is by separation from parents rather than by parental death. The type of separation usually implicated is the result of family or marital disturbance. In the case of alcoholics, separations from mother or both parents are important but separation from father alone is not. In narcotic addicts the above pattern was also observed but in addition, paternal separations due to marital dysharmony may be involved. These results are discussed in the light of family related theories of drug dependence.     

Quantitative Hemagglutination Studies in the Rh Blood Group System. II. A Study of the D (Rho) Agglutinogen

The reactivity of Rh positive red cells with saline anti-D sera has beeninvestigated by means of quantitative hemagglutination methods. The inhibitory effect of C on the D antigen has been confirmed and the possibility ofinhibition by this antigen in the cis position suggested. It is also suggested thatthe e antigen has suppressive effect on D. The presence of companion antigensresults in a -D-> R₂ > R_o > R₁ progression of decreasing agglutinability.Within families differences in the agglutination behavior between homozygousand heterozygous D positive cells were found. The heterogeneity of thisantigen was confirmed.

Accepted on November 20, 1960     

Expression of the Plasmodium berghei ookinete protein Pbs21 in a baculovirus-insect cell system produces an efficient transmission blocking immunogen

A surface protein of Plasmodium berghei ookinetes, Pbs21, was expressed in a baculovirus-insect cell system in cell culture and in Heliothis virescens larvae. Groups of BALB/c mice received two intraperitoneal inoculations of either i) Tris-buffer or homogenized H. virescens larvae infected with wild-type baculovirus; ii) enriched, homogenized ookinetes, or Hi) homogenizedH. virescens larvae expressing recombinant Pbs21 (rPbs21). All animals immunized with ookinetes or with rPbs21 had high litres of antibodies (IgG isotype) that bound to native Pbs21. The large majority of antibodies in immune sera of both groups recognized the antigen under non-reducing but not under reducing conditions. The predominant IgG-sub-classes in mice immunized with ookinetes was IgGl and in mice immunized with rPbs21, the subclasses were IgGl and IgG2a. Immunization with rPbs21 reduced the infec-tivity of P. berghei to mosquitoes by 91% compared to a 99% reduction following immunization with ookinetes. This preliminary data indicate that rPbs21 expressed in this eukaryotic system induces a transmission-blocking immunity which is more effective than that achieved using rPbsll expressed in Escherichia coli (Matsuoka et al. 1994).     

Childhood stunting and caries increment in permanent teeth: a three and a half year longitudinal study in Peru

International Journal of Paediatric Dentistry 2013; 23: 101–109 Background. Malnutrition has been consistently associated with caries in primary teeth, although an effect on permanent teeth has not been established because of the few longitudinal studies. Aim. To explore the association between stunting and caries increment in permanent teeth over 3.5 years. Design. In 2003, 121 children aged 7–9 years were randomly selected from nine underserved communities in Lima (Peru). Parents provided demographic information and a food diary for their children. Clinical examinations included assessments of height, weight, oral hygiene, and dental caries. Stunting was defined using the 2000 CDC and 2007 WHO standards. In 2006, 83 children were re‐examined, and the 3.5‐year net DMFS increment was calculated. The association between stunting and net DMFS increment was assessed using negative binomial regression. Results. Stunting was related to net DMFS increment after adjustment for sex and age, oral hygiene, sugary snacks between meals, and caries experience in primary and permanent teeth. Consistent results were found when using either the 2000 CDC (incidence rate ratio: 1.61; 95%CI: 1.07, 2.44) or 2007 WHO standards (IRR: 1.79; 95%CI: 1.28, 2.51). Conclusion. Stunting was a significant risk factor for caries increment in permanent teeth over a 3.5‐year period, independent of other well‐known risk factors for caries development.     

Neck circumference is associated with non-traditional cardiovascular risk factors in individuals at low-to-moderate cardiovascular risk: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Background

Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

807 individuals (35–54 years) without obesity, diabetes or cardiovascular disease was stratified into quartiles of NC (cut-off for men: 36.5; 37.9 and 39.5 cm; women: 31.4; 32.5 and 34 cm) and traditional and non-traditional risk factors (lipoprotein subfractions by Vertical Auto Profile, adiponectin, leptin, E-selectin) were compared across groups. In linear regression models, associations of NC with non-traditional risk factors were tested for the entire sample and for low-risk group (≤?2 CVRF).

Results

In both sexes, BMI, waist circumference, systolic and diastolic blood pressure, fasting and 2-h plasma glucose, HOMA-IR, triglycerides, leptin, E-selectin, small dense LDL-cholesterol, IDL-cholesterol, VLDL₃-cholesterol and TG/HDL ratio increased significantly, while HDL₂-cholesterol and HDL₃-cholesterol decreased across NC quartiles. In linear regression models, a direct association [β(95% CI)] of NC with leptin [(0.155 (0.068–0.242); 0.147 (0.075–0.220)], E-selectin [(0.105 (0.032–0.177); 0.073 (0.006 to 0.140)] and small-dense LDL [(1.866 (0.641–3.091); 2.372 (1.391–3.353)] and an inverse association with HDL₂-cholesterol [(??0.519 (??0.773 to ??0.266); ??0.815 (??1.115 to 0.515)] adjusted for age were detected for men and women, respectively.

Conclusion

Our findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.

     

Endoscann, a new endometrial cell sampler

Summary. The cytological diagnoses made on material obtained with a mechanical sampler, the'Endoscann', were compared with those from conventional histology after uterine curettage in a group of 200 patients (74% were postmenopausal). There was diagnostic agreement in 21 of 23 women with cancer and 2 of 5 with premalignant disease. A negative cytological result was only acceptable when the clinical assessment was also negative. With this proviso the instrument may be used for the screening of high-risk groups for endometrial cancer, and to investigate postmenopausal bleeding. As this is an outpatient procedure it can achieve considerable savings. Cell blocks suitable for staging of the endometrial cycle can be obtained from women with infertility.     

Quantitative Hemagglutination Studies in the Rh Blood Group System. I. The Assay of the Anti-D (Rho) Agglutinin

The quantitative hemagglutination technic of Wilkie and Becker has beenmodified for the assay of saline and incomplete anti-D sera. By this method,the relative potencies of anti-D (Rh_o) sera were determined with an averageerror of 29 per cent (95 per cent confidence limits). The effect of duration oftrypsin treatment upon the cell’s agglutination by incomplete antibody wasinvestigated. The sensitivity of the technic in discerning small changes inagglutination was applied to the characterization of the prozone. The presenceof a reversible equilibrium in the D-anti-D system has been established bytwo independent methods.

Accepted on November 20, 1960     

Does the newer preparation of propofol,an emulsion of medium/long chain triglycerides cause less injection pain in children when premixed with lignocaine?

Background: Injection pain during propofol administration can be particularly distressing in children. The newly available emulsion of propofol in medium and long chain triglycerides (LCT) is reported to cause less injection pain because of lower concentrations of free propofol. This study compared the incidence of injection pain during administration of propofol emulsion of LCT and propofol emulsion of medium and long chain triglycerides (MCT/LCT) both premixed with lignocaine in children. Methods: This prospective, randomized, double blind study was conducted after obtaining institutional ethics committee approval, parental consent and included 84 children aged 5–15 years. Preoperatively, an intravenous cannula was inserted in all children. four children were excluded. Those included, depending on the randomization, received 3 mg·kg^?1 of either propofol LCT or propofol MCT/LCT both premixed with lignocaine (0.1%). The incidence and intensity of injection pain was assessed. Results: Pain on injection of propofol LCT with lignocaine was observed in 16/40 children (40%), five of these children complained of severe pain. In comparison, 14/40 (35%) children complained of pain following propofol MCT/LCT premixed with lignocaine (P = 0.644), the intensity being severe in two children (P = 0.698). Conclusions: Propofol MCT/LCT and propofol LCT premixed with lignocaine are both associated with pain on injection in children; the incidence and intensity of the injection pain are similar.