Effect of hawthorn standardized extract on flow mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial

<p>Abstract</p> <p>Background</p> <p>Hawthorn extract has been used for cardiovascular diseases for centuries. Recent trials have demonstrated its efficacy for the treatment of heart failure, and the results of several small trials suggest it may lower blood pressure. However, there is little published evidence to guide its dosing. The blood pressure lowering effect of hawthorn has been linked to nitric oxide-mediated vasodilation. The aim of this study was to investigate the relationship between hawthorn extract dose and brachial artery flow mediated dilation (FMD), an indirect measure of nitric oxide release.</p> <p>Methods</p> <p>We used a four-period cross-over design to evaluate brachial artery FMD in response to placebo or hawthorn extract (standardized to 50 mg oligomeric procyanidin per 250 mg extract). Randomly sequenced doses of hawthorn extract (1000 mg, 1500 mg, and 2500 mg) and placebo were assigned to each participant. Doses were taken twice daily for 3 1/2 days followed by FMD and a 4-day washout before proceeding to the next dosing period.</p> <p>Results</p> <p>Twenty-one prehypertensive or mildly hypertensive adults completed the study. There was no evidence of a dose-response effect for our main outcome (FMD percent) or any of our secondary outcomes (absolute change in brachial artery diameter and blood pressure). Most participants indicated that if given evidence that hawthorn could lower their blood pressure, they would be likely to use it either in conjunction with or instead of lifestyle modification or anti-hypertensive medications.</p> <p>Conclusion</p> <p>We found no evidence of a dose-response effect of hawthorn extract on FMD. If hawthorn has a blood pressure lowering effect, it is likely to be mediated via an NO-independent mechanism.</p> <p>Trial Registration</p> <p>This trial has been registered with ClinicalTrials.gov, a service of the U.S. National Institutes of Health: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01331486">NCT01331486</a>.</p

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

INTERMED - an alternative to the psychosocial evaluation of transplant patients ? Results of a prospective study

Fragestellung: Bislang liegen zwei standardisierte Interviews zur Evaluierung der psychosozialen Situation von TX-Patienten vor: das Psychosocial Assessment of Candidates for Transplantation (PACT) und die Transplant Evaluation Rating Scale (TERS). Das Ziel der laufenden, multizentrischen Studie ist zu eruieren, ob sich 1. das halbstrukturierte Interview- und Ratingverfahren der biopsychosozialen Belastung und Versorgungsnotwendigkeit INTERMED (HUYSE et al., 2001) zur psychosozialen Evaluierung während der TX-Vorbereitung eignet, und 2. ob das INTERMED (IM) eine Vorhersage der Lebensqualität nach der TX ermöglicht. Methoden: 120 konsekutive Organ-TX-Kandidaten wurden während ihrer Wartezeit mit IM, TERS, SF-36 und HADS evaluiert. Die Konvergenzvalidität des IM mit den vergleichbaren klinischen Instrumenten wurde mittels Korrelationsanalysen, der Einfluss der vor der TX erhobenen Baseline-Variablen auf die abhängige Variable Körperliche Lebensqualität (SF-36) mittels linearen Regressionsanalysen untersucht. Ergebnisse: 73 Nieren-, 20 Leber- und 25 Herz-TX-Kandidaten wurden vor und bisher 30 Patienten 1 Jahr nach der TX untersucht. Die Konvergenz des IM mit der TERS (r ,524) und dem SF-36 (Körp. LQ r -,324; Psych. LQ r -,234) und HADS (r ,384) ist mittelgradig bis hoch. Das beste Prädiktormodell für die Körp. LQ (R2 ,72) der Patienten 1 Jahr nach der TX besteht aus den Merkmalen Alter (β -,52), Organ: Leber (β 12,9) und dem IM-Summenwert (β 1,25). Diskussion: Die konvergente und prädiktive Validität des IM für die Anwendung bei TX-Patienten konnten wir nachweisen. Gegenüber den anderen Instrumenten bietet das IM zusätzliche Vorteile für die klinische Praxis: neben Belastungen der Patienten werden auch soziale Integration und Versorgungsbedarf eingeschätzt bzw. kann direkt in weiterführende diagnost. und therapeut. Maßnahmen übergeleitet werden. Das IM bietet sich an, die gesundheitliche Entwicklung eines TX-Patienten abzuschätzen und präventive Maßnahmen zu treffen