Impaired aldosterone response to the saline infusion test in patients with resistant hypertension and obstructive sleep apnea

Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension.Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM).Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA.Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA.Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension.Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM).Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA.Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA

Current guidelines for blood pressure management in acute stroke

Udar mózgu jest jednostką nozologiczną obarczoną wysokim odsetkiem wczesnej śmiertelności oraz trudnym rokowaniem co do odzyskania sprawności. Aktualne zalecenia wspierają miejsce terapii hipotensyjnej w leczeniu ostrej fazy udaru mózgu, jako lek pierwszego rzutu wskazując labetalol. Lekiem kolejnej linii pozostaje nikardipina, a w wyjątkowych sytuacjach nitrogliceryna i nitroprusydek sodu. Pytanie o zasadność terapii hipotensyjnej w kontekście wczesnego rokowania u pacjentów z udarem mózgu budzą wyniki badania CATIS — w świetle danych płynących z badania nie ma dowodów na korzystny wpływ leczenia hipotensyjnego w ostrej fazie udaru mózgu na redukcję wczesnej śmiertelności i niepełnosprawności u pacjentów z udarem.Stroke is the nosological unit burdened high percentage of early mortality, difficult prognosis for the recovery efficiency. Current recommendations support the place of antihypertensive therapy in the treatment of acute stroke, as first-line indicating labetalol. Nicardipine is the next line drug, in exceptional circumstances, nitroglycerin and sodium nitroprusside. The question of the legitimacy of antihypertensive therapy in the context of early prognosis in patients with stroke raise the CATIS trial results — the findings of a study shows there is no evidence for a beneficial effect of antihypertensive treatment in the acute phase of stroke to reduce early mortality, disability in stroke patients

Aktualne wytyczne postępowania z nadciśnieniem tętniczym w ostrej fazie udaru mózgu

Udar mózgu jest jednostką nozologiczną obarczoną wysokim odsetkiem wczesnej śmiertelności oraz trudnym rokowaniem co do odzyskania sprawności. Aktualne zalecenia wspierają miejsce terapii hipotensyjnej w leczeniu ostrej fazy udaru mózgu, jako lek pierwszego rzutu wskazując labetalol. Lekiem kolejnej linii pozostaje nikardipina, a w wyjątkowych sytuacjach nitrogliceryna i nitroprusydek sodu. Pytanie o zasadność terapii hipotensyjnej w kontekście wczesnego rokowania u pacjentów z udarem mózgu budzą wyniki badania CATIS — w świetle danych płynących z badania nie ma dowodów na korzystny wpływ leczenia hipotensyjnego w ostrej fazie udaru mózgu na redukcję wczesnej śmiertelności i niepełnosprawności u pacjentów z udarem

Raman spectroscopy and the material study of nanocomposite membranes from poly(ε-caprolactone) with biocompatibility testing in osteoblast-like cells

Modern medical treatment can be improved by nanotechnology methods for preparing nanocomposites with novel physical, chemical and biological properties. The materials studied and analysed as membranes were produced from poly(ε-caprolactone) (PCL), which contained identical amounts of nano-additives, either montmorillonite (MMT) or functionalized multi-walled carbon nanotubes (MWCNT-f), while the reference membranes were obtained from unmodified PCL. In addition to the conventional methods used in the study of materials for medical purposes such as DSC, contact angle measurements, surface topography, Raman spectroscopy was also applied. Raman microspectroscopy can decode the phenomenon that occurs in the polymer in contact with the nanoparticles. Besides identifying the vibrations of certain functional groups, the calculation of crystallinity parameters is also possible, by which the most intense interactions within the nanocomposites can be analysed. The Raman studies indicate that each of the nano-additives reacts differently with the polymer matrix, which results in material properties that influence its biological properties. MWCNT-f interacts preferentially with the oxygen-containing groups, and particularly with the backbone regions in the vicinity of the single CO bond. The human osteoblast-like MG-63 cells, cultured on the PCL/MWCNT-f membrane for three days, show almost 100% viability

Cationic Emulsion Polymerization of Octamethylcyclotetrasiloxane (D4) in Mixtures with Alkoxysilanes

The cationic emulsion polymerization of octamethylcyclotetrasiloxane (D4) in mixtures with methyltriethoxysilane (MTES) and vinyltriethoxysilane (VTES) was studied by FTIR ATR, GC, the development of a toluene insoluble fraction of the polymer and a gravimetric analysis. The polymerization of D4 alone was also conducted for comparison and, additionally, the development of molecular weight of polydimethylsiloxane (PDMS) obtained in that process was studied by GPC. Dodecylbenzenesulphonic acid (DBSA) was used as a surfactant and catalyst. The process was carried out in a “starved feed” mode by adding dropwise the monomer mixture to the aqueous solution of DBSA. FTIR ATR spectra were recorded by the sensor placed in the probe tip of a ReactIR 15TM apparatus. It was found that the silicone polymer formation proceeded faster when D4 was polymerized in the mixture with alkoxysilanes, especially in the beginning of the process, and that already at the beginning of the process, the partly crosslinked polymer was formed. The induction period of ca. 30 min was observed and the concentration of cyclic siloxanes (D4 and decamethylcyclopentasiloxane—D5) remained at a very low level in the course of the reaction and only traces were detected in the final product. The particle size development in the course of the reaction was also studied and it was found that the particle size distribution was bimodal and was broadening as the reaction proceeded, though this phenomenon was less distinct when D4 was polymerized in the mixtures with alkoxysilanes. The structure of the reaction product was confirmed by 29Si NMR

Polish recommendations for lung ultrasound in internal medicine (POLLUS-IM)

Objective: The aim of this study was to establish recommendations for the use of lung ultrasound in internal medicine, based on reliable data and expert opinions. Methods: The bibliography from the databases (Pubmed, Medline, OVID, Embase) has been fully reviewed up to August 2017. Members of the expert group assessed the credibility of the literature data. Then, in three rounds, a discussion was held on individual recommendations (in accordance with the Delphi procedure) followed by secret voting. Results: Thirty-eight recommendations for the use of lung ultrasound in internal medicine were established as well as discussed and subjected to secret voting in three rounds. The first 31 recommendations concerned the use of ultrasound in the diagnosis of the following conditions: pneumothorax, pulmonary consolidation, pneumonia, atelectasis, pulmonary embolism, malignant neoplastic lesions, interstitial lung lesions, cardiogenic pulmonary edema, interstitial lung diseases with fibrosis, dyspnea, pleural pain and acute cough. Furthermore, seven additional statements were made regarding the technical conditions of lung ultrasound examination and the need for training in the basics of lung ultrasound in a group of doctors during their specialization programs and medical students. The panel of experts established a consensus on all 38 recommendations

Polskie zalecenia na temat zastosowania ultrasonografii płuc w chorobach wewnętrznych (POLLUS-IM

Objective: The aim of this study was to establish recommendations for the use of lung ultrasound in internal medicine, based on reliable data and expert opinions. Methods: The bibliography from the databases (Pubmed, Medline, OVID, Embase) has been fully reviewed up to August 2017. Members of the expert group assessed the credibility of the literature data. Then, in three rounds, a discussion was held on individual recommendations (in accordance with the Delphi procedure) followed by secret voting. Results: Thirty-eight recommendations for the use of lung ultrasound in internal medicine were established as well as discussed and subjected to secret voting in three rounds. The first 31 recommendations concerned the use of ultrasound in the diagnosis of the following conditions: pneumothorax, pulmonary consolidation, pneumonia, atelectasis, pulmonary embolism, malignant neoplastic lesions, interstitial lung lesions, cardiogenic pulmonary edema, interstitial lung diseases with fibrosis, dyspnea, pleural pain and acute cough. Furthermore, seven additional statements were made regarding the technical conditions of lung ultrasound examination and the need for training in the basics of lung ultrasound in a group of doctors during their specialization programs and medical students. The panel of experts established a consensus on all 38 recommendations.Cel: Celem niniejszej pracy było ustalenie opartych na wiarygodnych danych i opiniach ekspertów zaleceń dotyczących zastosowania ultrasonografii płuc w chorobach wewnętrznych. Metody: Piśmiennictwo z baz danych (PubMed, Medline, OVID, Embase) zostało w całości poddane przeglądowi do sierpnia 2017 roku. Członkowie grupy ekspertów ocenili wiarygodność danych z piśmiennictwa. Następnie w trzech 3 turach przeprowadzono dyskusję na temat poszczególnych zaleceń (zgodnie z systemem Delphi) i przeprowadzono tajne głosowanie. Wyniki: Utworzono 38 zaleceń dotyczących zastosowania ultrasonografii płuc w chorobach wewnętrznych, zalecenia przedyskutowano oraz poddano tajnemu głosowaniu w trzech turach. Pierwsze 31 zaleceń dotyczyło ultrasonograficznych kryteriów rozpoznawania: odmy opłucnej, konsolidacji miąższu płucnego, zapalenia płuc, niedodmy, zatorowości płucnej, złośliwych zmian nowotworowych, zmian śródmiąższowych płuc, kardiogennego obrzęku płuc, śródmiąższowych chorób płuc przebiegających z włóknieniem płuc, duszności, bólów opłucnowych oraz ostrego kaszlu. Ponadto powstało siedem dodatkowych stwierdzeń, dotyczących technicznych warunków wykonania badania ultrasonograficznego płuc, a także potrzeby szkoleń w zakresie podstaw ultrasonografii płuc w grupie specjalizujących się lekarzy i studentów. Panel ekspertów ustalił konsensus dotyczący wszystkich 38 zaleceń