Signal transduction underlying the control of urinary bladder smooth muscle tone by muscarinic receptors and β-adrenoceptors

The normal physiological contraction of the urinary bladder, which is required for voiding, is predominantly mediated by muscarinic receptors, primarily the M3 subtype, with the M2 subtype providing a secondary backup role. Bladder relaxation, which is required for urine storage, is mediated by β-adrenoceptors, in most species involving a strong β3-component. An excessive stimulation of contraction or a reduced relaxation of the detrusor smooth muscle during the storage phase of the micturition cycle may contribute to bladder dysfunction known as the overactive bladder. Therefore, interference with the signal transduction of these receptors may be a viable approach to develop drugs for the treatment of overactive bladder. The prototypical signaling pathway of M3 receptors is activation of phospholipase C (PLC), and this pathway is also activated in the bladder. Nevertheless, PLC apparently contributes only in a very minor way to bladder contraction. Rather, muscarinic-receptor-mediated bladder contraction involves voltage-operated Ca2+ channels and Rho kinase. The prototypical signaling pathway of β-adrenoceptors is an activation of adenylyl cyclase with the subsequent formation of cAMP. Nevertheless, cAMP apparently contributes in a minor way only to β-adrenoceptor-mediated bladder relaxation. BKCa channels may play a greater role in β-adrenoceptor-mediated bladder relaxation. We conclude that apart from muscarinic receptor antagonists and β-adrenoceptor agonists, inhibitors of Rho kinase and activators of BKCa channels may have potential to treat an overactive bladder

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

New transition metal silicoselenides possessing CdI2CdI_2-type structures

Three different kinds of first-row transition metal silicoselenides having $Cdl_2$-related structures have been synthesized. Vanadium and chromium form $VSiSe_3$ and Cr_1_+_x $SiSe_3$, which are similar to $MPSe_3$ crystallizing in a hexagonal structure. Manganese forms Mn_3_/_2SiSe_3 which is isostructural with Mn_3_/_2SiTe_3. With Fe, Co and Ni, a new type of silicoselenide of the formula $MSi_2$ $Se_4$ (M = Fe, Co or Ni) is obtained. These solids crystallize in the $Cdl_2/Cr_3S_4$ structure where M atoms and Si-Si pairs occupy the cation positions

Harmonic analysis of DC capacitor current in sinusoidal and space-vector modulated neutral-point-clamped inverters

The voltage ripple and power loss in the DC-capacitor of a voltage source inverter depend on the harmonic currents flowing through the capacitor. This paper presents a double Fourier series based analysis of the harmonic contents of the DC capacitor current in a three-level neutral-point clamped (NPC) inverter, modulated with sine-triangle pulse-width modulation (SPWM) or conventional space vector pulse-width modulation (CSVPWM) schemes. The analytical results are validated experimentally on a 3-kVA three-level inverter prototype. The capacitor current in an NPC inverter has a periodicity of 120(a similar to) at the fundamental or modulation frequency. Hence, this current contains third-harmonic and triplen-frequency components, apart from switching frequency components. The harmonic components vary with modulation index and power factor for both PWM schemes. The third harmonic current decreases with increase in modulation index and also decreases with increase in power factor in case of both PWM methods. In general, the third harmonic content is higher with SPWM than with CSVPWM at a given operating condition. Also, power loss and voltage ripple in the DC capacitor are estimated for both the schemes using the current harmonic spectrum and equivalent series resistance (ESR) of the capacitor

Preparation, Structure, and Magnetic Properties of La3MAIS7La_3MAIS_7, and La3MFeS7La_3MFeS_7 (M = Mg, Mn, Fe, Co, Ni, or Zn)

A series of quaternary metal sulfides of the general formula $La_3MM'S_7$ (M = Mn, Fe, Co; M’ = Al and M = Mg, Mn, Fe, Co, Ni; M’ = Fe) consisting of linear chains of face shared $MS_6$ octahedra and isolated $M’S_4$ tetrahedra has been prepared and studied. The aluminium compounds $La_3MAIS_7$ (M = Mn, Fe, Co) exhibit linear chain antiferromagnetism. Magnetic behavior of other $La_3MFeS_7$ sulfides has been examined in detail. The magnetic susceptibility of $La_3MgFeS_7$ shows that tetrahedral site $Fe^{3+}$ undergoes a transition from S = 5/2 to S = 2 spin state around 150 K

Formation of novel molybdenum and tungsten sulfides by reduction of MOS2MOS_2 and WS2WS_2 disulfide: a new route to Chevrel phases

Pt-catalyzed hydrogen reduction of $MoS_2$ and $WS_2$ at 1000–1050°C yields new metal-rich sulfides $M_{21}S_8$ and $M_{14}S_5$ (M =Mo or W). The reduction of $MoS_2$ proceeds via the intermediate $Mo_6S_8$. Chevrel phases, $Cu_xMo_6S_8$(x < 4.0) and $Ni_2Mo_6S_8$, are readily prepared by hydrogen reduction of $MoS_2$ in the presence of the ternary metal