Determinants of medication adherence to antihypertensive medications among a Chinese population using Morisky medication adherence scale

<b>Background and objectives</b> Poor adherence to medications is one of the major public health challenges. Only one-third of the population reported successful control of blood pressure, mostly caused by poor drug adherence. However, there are relatively few reports studying the adherence levels and their associated factors among Chinese patients. This study aimed to study the adherence profiles and the factors associated with antihypertensive drug adherence among Chinese patients.<p></p> <b>Methods</b> A cross-sectional study was conducted in an outpatient clinic located in the New Territories Region of Hong Kong. Adult patients who were currently taking at least one antihypertensive drug were invited to complete a self-administered questionnaire, consisting of basic socio-demographic profile, self-perceived health status, and self-reported medication adherence. The outcome measure was the Morisky Medication Adherence Scale (MMAS-8). Good adherence was defined as MMAS scores greater than 6 points (out of a total score of 8 points).<p></p> <b>Results</b> From 1114 patients, 725 (65.1%) had good adherence to antihypertensive agents. Binary logistic regression analysis was conducted. Younger age, shorter duration of antihypertensive agents used, job status being employed, and poor or very poor self-perceived health status were negatively associated with drug adherence.<p></p> <b>Conclusion</b> This study reported a high proportion of poor medication adherence among hypertensive subjects. Patients with factors associated with poor adherence should be more closely monitored to optimize their drug taking behavior

ENSAT registry-based randomized clinical trials for adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is an orphan disease lacking effective systemic treatment options. The low incidence of the disease and high cost of clinical trials are major obstacles in the search for improved treatment strategies. As a novel approach, registry-based clinical trials have been introduced in clinical research, so allowing for significant cost reduction, but without compromising scientific benefit. Herein, we describe how the European Network for the Study of Adrenal Tumours (ENSAT) could transform its current registry into one fit for a clinical trial infrastructure. The rationale to perform randomized registry-based trials in ACC is outlined including an analysis of relevant limitations and challenges. We summarize a survey on this concept among ENSAT members who expressed a strong interest in the concept and rated its scientific potential as high. Legal aspects, including ethical approval of registry-based randomization were identified as potential obstacles. Finally, we describe three potential randomized registry-based clinical trials in an adjuvant setting and for advanced disease with a high potential to be executed within the framework of an advanced ENSAT registry. Thus we, therefore, provide the basis for future registry-based trials for ACC patients. This could ultimately provide proof-of-principle of how to perform more effective randomized trials for an orphan disease

Pneumothorax, pneumomediastinum, subcutaneous emphysema: serious complications of asthma

Bronchial asthma, is a quite common disease characterized by the chronic inflammation of the airways. It is due to the interaction of genetic with environmental factors. Currently, bronchial asthma is regarded as a public health problem, since its prevalence is constantly increasing worldwide. Common symptoms associated with asthma include repeated episodes of wheeze, dyspnoea, chest tightness and cough. Although commonly most asthmatic episodes are resolved with medical treatment, at times serious complications can deteriorate the clinical picture. Among these complications, the simultaneous spontaneous bilateral pneumothorax, the subcutaneous emphysema and the pneumomediastinum are life threatening complications

Protective effect of salicylates against hydrogen peroxide stress in yeast

Aims: To investigate the effects of salicylates in Saccharomyces cerevisiae exposed to oxidative stress induced by hydrogen peroxide (H2O 2). Methods and Results: Saccharomyces cerevisiae was cultured through to the postlogarithmic phase of growth. Stress was induced by the addition of 1·5 mmol l-1 H2O2 for 1 h, while N-acetyl-l-cysteine (NAC) and glutathione (GSSG) were used as control agents that affect the redox balance. Sodium salicylate, at 0·01-10 mmol l-1or acetylsalicylic acid, at 0·02-2·5 mmol l -1 was administered at various times before hydrogen peroxide stress. Both agents conferred resistance to a subsequent hydrogen peroxide stress, similarly to the induction of the adaptive response observed upon pretreatment with NAC and GSSG. Sodium salicylate was more potent as a short-term, but not as a long-term pretreatment agent, compared to acetylsalicylic acid. Conclusions: Pharmacological pretreatment with salicylates resulted in dose related increases in cell survival, indicating the induction of the protective response in yeast. Significance and Impact of the study: The possible role of salicylates in the modulation of the hydrogen peroxide stress response in eukaryotic cells address questions on the effects of these commonly used therapeutic agents in a number of disorders exhibiting an oxidative stress component. © 2009 The Authors

Pharmacological modulation of oxidative stress response in minimally invasive surgery: Systematic review

This systematic review aims to synthesize the data on the effectiveness of pharmacological modulation of stress response in minimally invasive surgery. Eligible trials were clinical trials randomized or not or experimental trials that investigated the effect of pharmacological agents on modulation of surgical stress response to minimally invasive surgery. No clinical trials were identified. Eight experimental trials met the inclusion criteria and were obtained in full text. Experimental models were rats or rabbits subjected to pneumoperitoneum, or pneumoretroperitoneum, not to a whole operation. Pharmacological modulation of surgical stress response was attempted with erythromycin, melatonin, mesna, verapamil, pentoxifylline, N-acetylcysteine, and zinc. All the pharmacological agents, except pentoxifylline, seemed to reduce oxidative stress markers. However, only mesna pretreatment prevented oxidative stress, because oxidative stress markers remained in the sham levels. Contrasting data were obtained for pentoxyphilline. In conclusion, available data suggest that pharmacological modulation of surgical stress response to minimally invasive surgery might be feasible. Copyright © 2012 by Lippincott Williams & Wilkins

Minimally invasive surgery and oxidative stress response: What have we learned from animal studies?

Oxidative stress (OS) is an integral part of the surgical stress response. Minimally invasive surgery causes less trauma, and thus attenuated stress response is anticipated. However, the pneumoperitoneum or pneumoretroperitoneum is implicated in free radical production. This study reviewed available data on the impact of minimally invasive surgery on OS response of animal models in a systematic way. Databases were searched up to and including January 2010. Most of the studies investigated the effect of pneumoperitoneum on OS, 3 studies investigated the effect of pneumoretroperitoneum on OS. There was a great heterogeneity on experimental conditions including animal models, measured OS markers, methods, and time periods of measurement. Published animal data do not allow a reliable conclusion on the effect of minimally invasive surgery on OS because of the great heterogeneity of experimental conditions. Besides, most studies focus on the effect of pneumoperitoneum, without taking into consideration the effect of less surgical trauma. Copyright © 2013 by Lippincott Williams & Wilkins

Virtual reality simulators and training in laparoscopic surgery

Virtual reality simulators provide basic skills training without supervision in a controlled environment, free of pressure of operating on patients. Skills obtained through virtual reality simulation training can be transferred on the operating room. However, relative evidence is limited with data available only for basic surgical skills and for laparoscopic cholecystectomy. No data exist on the effect of virtual reality simulation on performance on advanced surgical procedures. Evidence suggests that performance on virtual reality simulators reliably distinguishes experienced from novice surgeons Limited available data suggest that independent approach on virtual reality simulation training is not different from proctored approach. The effect of virtual reality simulators training on acquisition of basic surgical skills does not seem to be different from the effect the physical simulators. Limited data exist on the effect of virtual reality simulation training on the acquisition of visual spatial perception and stress coping skills. Undoubtedly, virtual reality simulation training provides an alternative means of improving performance in laparoscopic surgery. However, future research efforts should focus on the effect of virtual reality simulation on performance in the context of advanced surgical procedure, on standardization of training, on the possibility of synergistic effect of virtual reality simulation training combined with mental training, on personalized training. © 2014 Surgical Associates Ltd

Clinical implications of the histologically and immunohistochemically detected solitary lymph node metastases in gastric cancer

Background: Topographic correlation between the primary gastric tumor and the first peri- and extragastric lymphatic drain basin (solitary lymph node metastasis) on gastrectomy specimens, represents a reliable method to investigate and understand the exact pattern of lymphatic drainage from a gastric tumor. Analyzing that correlation, useful information regarding the extent of the appropriate oncological perigastric lymphadenectomy will be provided. We retrospectively evaluate the usefulness of a modified D2 lymphadenectomy in gastric cancer patients, based on the topographic correlation between the primary tumor and the location of the solitary lymph node metastases, as they were detected by histology and immunohistochemistry. Materials and Method: Between April 2003 and March 2010, 134 gastric cancer patients were submitted to a modified D2 lymphadenectomy. Postoperatively, the standard histological examination by hematoxylin and eosin (HE) staining, disclosed metastatic infiltration of at least two lymph nodes in 90 patients, solitary lymph node metastases were histologically detected in 10 patients, while the remaining 34 patients were classified as pN0. All lymph nodes of the ten patients with histological solitary lymph node metastases, as well as the 34 patients who had been classified as pN0 by histology, were further submitted to immunohistochemistry for micrometastases detection. More than one micrometastases were detected in none of them, while in seven patients solitary micrometastases were detected either in the level I perigastric or in the level II extragastric lymph nodes stations (skip micrometastases). Results: Solitary lymph node metastases were detected by histology in ten patients and by immunohistochemistry in additional seven (nine females and eight males). Solitary metastases were detected in the level I LN stations in seven patients (four by histology and three by immunohistochemistry) and in the level II LN stations in ten patients (six by histology and four by immunohistochemistry). In order of frequency, the solitary lymph node metastases were located in the no 7 (n = 6), no 6 (n = 4), no 9 (n = 2), no 5 (n = 2), no 4 (n = 1), no 8 (n = 1) and no 12 (n = 1) LN stations. Skip metastases encounteredthe 60% of the histologically detected, 57% of the immunohistochemically detected and 59% of all solitary lymph node metastases. 80% of solitary metastases in the level II LN stations, were mainly located in the nos 7-9 lymph node stations complex. Tumors of the lower and middle-third of the stomach were equally drained both to the level I and level II lymph node stations, while 67% of the tumors towards the lesser curvature, were mainly drained in the level II lymph node stations. Conclusion: D2 lymphadenectomy increases the number of true R0 resections. Thus, a modified D2 lymphadenectomy should be routinely performed in gastric cancer patients