Treatment of atherosclerotic renovascular hypertension: review of observational studies and a meta-analysis of randomized clinical trials.

open9Atherosclerotic renal artery stenosis can cause ischaemic nephropathy and arterial hypertension. We herein review the observational and randomized clinical trials (RCTs) comparing medical and endovascular treatment for control of hypertension and renal function preservation. Using the Population Intervention Comparison Outcome (PICO) strategy, we identified the relevant studies and performed a novel meta-analysis of all RCTs to determine the efficacy and safety of endovascular treatment when compared with medical therapy. The following outcomes were examined: baseline follow-up difference in mean systolic and diastolic blood pressure (BP), serum creatinine, number of drugs at follow-up, incident events (heart failure, stroke, and worsening renal function), mortality, cumulative relative risk of heart failure, stroke, and worsening renal function. Seven studies comprising a total of 2155 patients (1741 available at follow-up) were considered, including the recently reported CORAL Study. Compared with baseline, diastolic BP fell more at follow-up in patients in the endovascular than in the medical treatment arm (standard difference in means -0.21, 95% confidence interval (CI): -0.342 to -0.078, P = 0.002) despite a greater reduction in the mean number of antihypertensive drugs (standard difference in means -0.201, 95% CI: -0.302 to -0.1, P < 0.001). At variance, follow-up changes (from baseline) of systolic BP, serum creatinine, and incident cardiovascular event rates did not differ between treatment arms. Thus, patients with atherosclerotic renal artery stenosis receiving endovascular treatment required less anti-antihypertensive drugs at follow-up than those medically treated. Notwithstanding this, they evidenced a better control of diastolic BP.openopenCaielli P;Frigo AC;Pengo MF;Rossitto G;Maiolino G;Seccia TM;Calò LA;Miotto D;Rossi GPCaielli, P; Frigo, ANNA CHIARA; Pengo, Mf; Rossitto, G; Maiolino, G; Seccia, TERESA MARIA; Calò, La; Miotto, Diego; Rossi, Gianpaol

Energetic metabolism in fasting sheep: regularization of metabolic profile by treatment with oral glucose, with prior handling of gastric groove

The objective of this research was to evaluate a possible corrective measure against negative metabolic states, as occurs in the advanced stage of gestation in ewes, and that sometimes produces a disease called pregnancy toxaemia. In the present research, we found that the joint administration of i.v. lysine-vasopressin (0.08 IU/kg body weight, BW) and an oral glucose solution (50 g) produces an increase in blood glucose, which persists for some time (up to 6 h); therefore, it could be used in the treatment of pregnancy toxaemia. This therapy is based on the fact that lysine-vasopressin induces gastric groove closure in adult ruminants, enabling orally administered glucose to reach the abomasum directly, from where it rapidly passes into the intestine and is immediately absorbed. We can say that the tested treatment causes a significant increase in blood glucose in ewes affected by toxaemia caused by fasting, which, although less marked than conventional therapy with intravenous drip glucose, remains longer, regularizing other parameters indicative of energy metabolism in fasting ewes

Ion cyclotron wall conditioning experiments on Tore Supra in presence of the toroidal magnetic field

Wall conditioning techniques applicable in the presence of the high toroidal magnetic field will be required for the operation of ITER for tritium removal, isotopic ratio control and recovery to normal operation after disruptions. Recently ion cyclotron wall conditioning (ICWC) experiments have been carried out on Tore Supra in order to assess the efficiency of this technique in ITER relevant conditions. The ICRF discharges were operated in He/H-2 Mixtures at the Tore Supra nominal field (3.8 T) and a RF frequency of 48 MHz, i.e. within the ITER operational space. RF pulses of 60 s (max.) were applied using a standard Tore Supra two-strap resonant double loop antenna in ICWC mode, operated either in pi or 0-phasing with a noticeable improvement of the RF coupling in the latter case. In order to assess the efficiency of the technique for the control of isotopic ratio the wall was first preloaded using a D-2 glow discharge. After 15 minutes of ICWC in He/H-2 gas mixtures the isotopic ratio was altered from 4% to 50% at the price of an important H implantation into the walls. An overall analysis comparing plasma production and the conditioning efficiency as a function of discharge parameters is given

Geometric Aspects of Ambrosetti-Prodi operators with Lipschitz nonlinearities

For Dirichlet boundary conditions on a bounded domain, what happens to the critical set of the Ambrosetti-Prodi operator if the nonlinearity is only a Lipschitz map? It turns out that many properties which hold in the smooth case are preserved, despite of the fact that the operator is not even differentiable at some points. In particular, a global Lyapunov-Schmidt decomposition of great convenience for numerical inversion is still available

Septate uterus: nosographic overview and endoscopic treatment

To comment on the prevalence, diagnosis, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome, we searched publications in PubMed and Embase. Original articles, meta-analysis, reviews, and opinion articles were selected. The studies suggest that the prevalence of the septate uterus is increased in women with repeated pregnancy loss and infertility. Reliable diagnosis depends on accurate assessment of the uterine fundal contour and uterine cavity by means of magnetic resonance and three-dimensional ultrasound. Pertinent published data comparing pregnancy outcome before and after hysteroscopic metroplasty indicated a marked improvement after surgery. Magnetic resonance and three-dimensional ultrasound represent the gold standard for diagnosis of septate uterus. Hysteroscopic metroplasty with its simplicity, minimal postoperative sequelae, and improved reproductive outcome is the gold standard for treatment, not only in patients with recurrent pregnancy loss and premature labor but also in patients with infertility, especially if in vitro fertilization is being contemplated

Genotyping and antifungal susceptibility of Dipodascus capitatus isolated in a neonatal intensive care unit of a sicilian hospital

In August 2015, Dipodascus capitatus was isolated from two patients admitted to the neonatal intensive care unit. Nosocomial acquisition of the fungus was suspected and epidemiological studies were undertaken. The patients were simultaneously hospitalized, and the comparison of the two isolates by two independent molecular typing methods have confirmed clonal dissemination of a single strain of D. capitatus. Antimicrobial susceptibility testing was useful for identifying the appropriated antifungal therapy in micafungin. To our knowledge these are the first described cases of neonatal D. capitatus infection and also the first report of successful treatment by micafungin.In August 2015, Dipodascus capitatus was isolated from two patients admitted to the neonatal intensive care unit. Nosocomial acquisition of the fungus was suspected and epidemiological studies were undertaken. The patients were simultaneously hospitalized, and the comparison of the two isolates by two independent molecular typing methods have confirmed clonal dissemination of a single strain of D. capitatus. Antimicrobial susceptibility testing was useful for identifying the appropriated antifungal therapy in micafungin. To our knowledge these are the first described cases of neonatal D. capitatus infection and also the first report of successful treatment by micafungin

Cytokine gene polymorphisms and serum cytokine levels in patients with idiopathic pulmonary fibrosis

BACKGROUND: Studies have demonstrated associations between cytokine gene polymorphisms and the risk of idiopathic pulmonary fibrosis (IPF). We therefore examined polymorphisms in the genes encoding interleukin (IL)-6, IL-10, interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), and transforming growth factor-beta 1 (TGF-β(1)), and compared the serum levels of these cytokines in IPF patients and healthy controls. Furthermore, we examined the association of the studied genotypes and serum cytokine levels with physiological parameters and the extent of parenchymal involvement determined by high-resolution computed tomography (HRCT). METHODS: Sixty patients with IPF and 150 healthy controls were included. Cytokine genotyping was performed using the polymerase chain reaction sequence specific primer (PCR-SSP) method. In a subset of patients and controls, serum cytokine levels were determined by enzyme-linked immunosorbent assay. RESULTS: There was no difference between IPF patients and controls in the genotype and allele distributions of polymorphisms in TNF-α, IFN-γ, IL-6, IL-10, and TGF-β(1) (all p > 0.05). The TNF-α (−308) GG, IL-6 (−174) GG and CG, and IL-10 (−1082, -819, -592) ACC ATA genotypes were significantly associated with HRCT scores (all p < 0.05). IL-10 (−1082, -819, -592) ACC haplotype was associated with the diffusion capacity of the lung for carbon monoxide, and ATA haplotype was associated with the partial pressure of oxygen (PaO(2)) (all p < 0.05). The TGF-β(1) (codons 10 and 25) TC GG, TC GC, CC GG and CC GC genotypes were significantly associated with the PaO(2) and HRCT scores (p < 0.05). The TGF-β(1) (codons 10 and 25) CC GG genotype (5 patients) was significantly associated with higher PaO(2) value and less parenchymal involvement (i.e., a lower total extent score) compared to the other TGF-β(1) genotypes (81.5 ± 11.8 mm Hg vs. 67.4 ± 11.1 mm Hg, p = 0.009 and 5.60 ± 1.3 vs. 8.51 ± 2.9, p = 0.037, respectively). Significant differences were noted between patients (n = 38) and controls (n = 36) in the serum levels of IL-6 and IL-10 (both, p < 0.0001), but not in the levels of TNF-α and TGF-β(1) (both, p > 0.05). CONCLUSION: The studied genotypes and alleles do not predispose to the development of IPF but appear to play an important role in disease severity. Our results suggest that the TGF-β(1) (codons 10 and 25) CC GG genotype could be a useful genetic marker for identifying a subset of IPF patients with a favorable prognosis; however, validation in a larger sample is required

Divisiones del sector de empleo y comportamiento político en la clase de servicio. España, 1989-2000

The sector of employment, public or private, has been considered an influencing variable on political behaviour. The most spread thesis asserts that people who work in the private sector support above all conservative parties or those parties that stand for cutting down taxes, and those working in the public sector will vote for labour or socialist parties or those parties that support the expansion of the public administration. The Spanish case had not been well studied, and the work that I present here analyse only the behaviour of the service class. The main conclusions achieved are: 1. The relationship between employment sector and vote has been very stable during the researched period (1989-2000); 2. The sector effect on vote has been a small one, and it has been partially due to the different sector's occupational composition; 3. The only party that has been influenced by sector for long is Izquierda Unida (United Left).El sector de empleo, público o privado, ha llegado a ser considerado una variable con influencia en el comportamiento político. La tesis más difundida afirma que los individuos que desenvuelven sus tareas en el sector privado apoyarán mayormente a partidos de derechas o con un interés en rebajar la carga impositiva, mientras que aquéllos vinculados al sector público votarán a partidos de izquierdas o más tendentes a promover la expansión de la administración pública. El caso español apenas había sido estudiado, y el trabajo que aquí se presenta analiza únicamente el comportamiento de los individuos miembros de la clase de servicio. Las principales conclusiones alcanzadas son las siguientes: 1) la relación entre sector de empleo y voto ha mostrado una gran estabilidad a lo largo del período estudiado (1989-2000); 2) el efecto del sector en el voto ha sido pequeño, y parte del mismo puede ser explicado por la composición ocupacional de cada uno de los sectores; 3) el único partido para el que se observa una influencia sostenida del sector es Izquierda Unida

A Lacunarity-Based Index for Spatial Heterogeneity

Characteri zing spatial heterogeneity is fundamental in numerous areas, yet defining spatial patterns often depends on qualitative assessments or a priori knowledge. Lacunarity analysis is a popular occupancy-based method for identi fy ing relevant length scales in spatially heterogeneous systems. From lacunarity, we identify the ex istence of a point which encapsulates the spatial heterogeneity of a given system. This value sati sfies the conditions for the lac unarity cutoff function and forms the bas is of a heterogeneity index. We evaluate the behavior of both parameters in mono fractal, clustered, and periodic systems. ln addition, we demonstrate the broad utility of our approach to the scientific community by classifying the spati al heterogeneity of fractured sea ice and comparing our findings to ex isting measures. The heterogeneity index produced a linear correlation with the area fraction of open ocean to ice with an R2 of 0.967