Aliskiren monotherapy does not cause paradoxical blood pressure rises: meta-analysis of data from 8 clinical trials.

Angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and diuretics all cause reactive rises in plasma renin concentration, but particularly high levels have been reported with aliskiren. This prompted speculation that blockade of plasma renin activity with aliskiren could be overwhelmed, leading to paradoxical increases in blood pressure. This meta-analysis of data from 4877 patients from 8 randomized, double-blind, placebo- and/or active-controlled trials examined this hypothesis. The analysis focused on the incidence of paradoxical blood pressure increases above predefined thresholds, after > or =4 weeks of treatment with 300 mg of aliskiren, angiotensin receptor blockers (300 mg of irbesartan, 100 mg of losartan, or 320 mg of valsartan), 10 mg of ramipril, 25 mg of hydrochlorothiazide, or placebo. There were no significant differences in the frequency of increases in systolic (>10 mm Hg; P=0.30) or diastolic (>5 mm Hg; P=0.65) pressure among those treated with aliskiren (3.9% and 3.1%, respectively), angiotensin receptor blockers (4.0% and 3.7%), ramipril (5.7% and 2.6%), or hydrochlorothiazide (4.4% and 2.7%). Increases in blood pressure were considerably more frequent in the placebo group (12.6% and 11.4%; P<0.001). None of the 536 patients with plasma renin activity data who received 300 mg of aliskiren exhibited an increase in systolic pressure >10 mm Hg that was associated with an increase in plasma renin activity >0.1 ng/mL per hour. In conclusion, the incidence of blood pressure increases with aliskiren was similar to that during treatment with other antihypertensive drugs. Blood pressure rises on aliskiren treatment were not associated with increases in plasma renin activity. This meta-analysis found no evidence that aliskiren uniquely causes paradoxical rises in blood pressure.

Decreased glucose-induced thermogenesis after weight loss in obese subjects: a predisposing factor for relapse of obesity?

Glucose-induced thermogenesis (GIT) after a 100-g oral glucose load was measured by continuous indirect calorimetry in 32 nondiabetic and diabetic obese subjects and compared to 17 young and 13 middle aged control subjects. The obese subjects were divided into three groups: A (n = 12) normal glucose tolerance, B (n = 13) impaired glucose tolerance, and C (n = 7) diabetics, and were studied before and after a body weight loss ranging from 9.6 to 33.5 kg consecutive to a 4 to 6 months hypocaloric diet. GIT, measured over 3 h and expressed as percentage of the energy content of the load, was significantly reduced in obese groups A and C (6.2 +/- 0.6, and 3.8 +/- 0.7%, respectively) when compared to their age-matched control groups: 8.6 +/- 0.7 (young) and 5.8 +/- 0.3% (middle aged). Obese group B had a GIT of 6.1 +/- 0.6% which was lower than that of the young control group but not different from the middle-aged control group. After weight loss, GIT in the obese was further reduced in groups A and B than before weight loss: ie, 3.4 +/- 0.6 (p less than 0.001), 3.7 +/- 0.5 (p less than 0.01) respectively, whereas in group C, weight loss induced no further diminution in GIT (3.8 +/- 0.6%). These results support the concept of a thermogenic defect after glucose ingestion in obese individuals which is not the consequence of their excess body weight but may be one of the factors favoring the relapse of obesity after weight loss.

Influence of triamcinolone intravitreal injection on retinochoroidal healing processes.

To analyze the effects of triamcinolone intravitreal injection on the wound healing processes after argon laser retinal photocoagulation, wild type C57BL/6J mice, 8-12 weeks old underwent a standard argon laser photocoagulation protocol. After pentobarbital anesthesia and pupil dilatation, argon laser lesions were induced (50microm, 400mW, 0.05s). Two photocoagulation impacts created two disc diameters from the optic nerve in both eyes. The photocoagulated mice were divided into four groups: Group I (n=12), photocoagulation controls, did not receive any intravitreous injection. Group II (n=12), received an intravitreous injection of 1microl of balanced salt solution (BSS). Group III (n=12), received an intravitreous injection of 1microl containing 15microg of triamcinolone acetonide (TAAC) in BSS. Two mice from each of these three groups were sacrificed at 1, 3, 7, 14 days and 2 and 4 months after photocoagulation. Group IV (n=10) received 1.5, 3, 7.5, 15, or 30microg of TAAC and were all sacrificed on day 14. The enucleated eyes were subjected to systematic analysis of the cellular remodeling processes taking place within the laser lesion and its vicinity. To this purpose, specific antibodies against GFAP, von Willebrand factor, F4/80 and KI67 were used for the detection of astrocytes, activated Müller cells, vascular endothelial cells, infiltrating inflammatory cells and actively proliferating cells. TUNEL reaction was also carried out along with nuclear DAPI staining. Temporal and spatial observations of the created photocoagulation lesions demonstrate that 24h following the argon laser beam, a localized and well-delineated affection of the RPE cells and choroid is observed in mice in Groups I and II. The inner retinal layers in these mice eyes are preserved while TUNEL positive (apoptotic) cells are observed at the retinal outer nuclear layer level. At this stage, intense staining with GFAP is associated with activated retinal astrocytes and Müller cells throughout the laser path. From day 3 after photocoagulation, dilated new choroidal capillaries are detected on the edges of the laser lesion. These processes are accompanied by infiltration of inflammatory cells and the presence of proliferating cells within the lesion site. Mice in Group III treated with 15microg/mul of triamcinolone showed a decreased number of infiltrating inflammatory cells and proliferating cells, which was not statistically significant compared to uninjected laser treated controls. The development of new choroidal capillaries on the edges of the laser lesion was also inhibited during the first 2 months after photocoagulation. However, on month 4 the growth of new vessels was observed in these mice treated with TAAC. Mice of Group IV did not show any development of new capillaries even with small doses. After argon laser photocoagulation of the mouse eye, intravitreal injection of triamcinolone markedly influenced the retina and choroid remodeling and healing processes. Triamcinolone is a powerful inhibitor of the formation of neovessels in this model. However, this inhibition is transient. These observations should provide a practical insight for the mode of TAAC use in patients with wet AMD.

Improved Surgical Technique Reduces Complications at the Gastro-jejunostomy After Laparoscopic Roux-en-Y Gastric Bypass

Introduction: Roux-en-Y gastric bypass (RYGBP) is one of the commonest procedure for morbid obesity. It is associated with effective long-term weight loss, but can lead to significant complications, especially at the gastrojejunostomy (GJS) Patients and Methods: All the patients undergoing laparoscopic RYGBP at one of our two institutions were included in this study, in which we compared two different techniques for the construction of the GJS and their effects on the incidence of complications. In group A, anatomosis was performed on the posterior aspect of the gastric pouch. In group B it was performed across the staple line used to form the gastric pouch. A 21-mm circular stapler was used in all patients. Results: A total of 1128 patients were included between June 1999 and September 2009, 639 in group A and 488 in group B. Sixty patients developed a total of 65 complications at the GJS, with 14 (1,2 %) leaks, 42 (3,7 %) stricture, and 9 (0,8 %) marginal ulcers. Leaks (0,2 versus 2 %, p=0,005) and strictures (0,8 versus 5,9%, p<0,0001) were significantly fewer in group B than in group A. Conclusions: Improved surgical technique, with the GJS across the staple line used to form the gastric pouch, significantly reduces the rate of anastomotic complications at the GJS. A circular 21-mm stapler can be used with a low complication rate, and especially a low stricture rate. Additional methods to limit complications at the GJS are probably not routinely warranted.

Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study.

BACKGROUND AND PURPOSE: Sleep disordered breathing (SDB) is frequent in acute stroke patients and is associated with early neurologic worsening and poor outcome. Although continuous positive airway pressure (CPAP) effectively treats SDB, compliance is low. The objective of the present study was to assess the tolerance and the efficacy of a continuous high-flow-rate air administered through an open nasal cannula (transnasal insufflation, TNI), a less-intrusive method, to treat SDB in acute stroke patients. METHODS: Ten patients (age, 56.8 ± 10.7 years), with SDB ranging from moderate to severe (apnea-hypopnea index, AHI, >15/h of sleep) and on a standard sleep study at a mean of 4.8 ± 3.7 days after ischemic stroke (range, 1-15 days), were selected. The night after, they underwent a second sleep study while receiving TNI (18 L/min). RESULTS: TNI was well tolerated by all patients. For the entire group, TNI decreased the AHI from 40.4 ± 25.7 to 30.8 ± 25.7/h (p = 0.001) and the oxygen desaturation index >3% from 40.7 ± 28.4 to 31 ± 22.5/h (p = 0.02). All participants except one showed a decrease in AHI. The percentage of slow-wave sleep significantly increased with TNI from 16.7 ± 8.2% to 22.3 ± 7.4% (p = 0.01). There was also a trend toward a reduction in markers of sleep disruption (number of awakenings, arousal index). CONCLUSIONS: TNI improves SDB indices, and possibly sleep parameters, in stroke patients. Although these changes are modest, our findings suggest that TNI is a viable treatment alternative to CPAP in patients with SDB in the acute phase of ischemic stroke.

¿Cómo se lee y escribe en línea?

Se pretende averiguar, en base a datos de una investigación en curso, cómo se lee y escribe en clase cuando cada aprendiz dispone de portátil, está conectado a la red y el libro de texto es digital.

HBV or HCV coinfections and risk of myocardial infarction in HIV-infected individuals: the D:A:D Cohort Study.

BACKGROUND: Data on a link between HCV or HBV infection and the development of cardiovascular disease among HIV-negative and HIV-positive individuals are conflicting. We sought to investigate the association between HBV or HCV infection and myocardial infarction in HIV-infected individuals. METHODS: The prospective observational database of the D:A:D collaboration of 11 cohorts of HIV-infected individuals, including 212 clinics in Europe, the United States and Australia was used. Multivariate Poisson regression was used to assess the effect of HCV or HBV infection on the development of myocardial infarction after adjustment for potential confounders, including cardiovascular risk factors, diabetes mellitus and exposure to antiretroviral therapy. RESULTS: Of 33,347 individuals, 517 developed a myocardial infarction over 157,912 person-years, with an event rate of 3.3 events/1,000 person-years (95% confidence interval [CI] 3.0-3.6). Event rates (95% CIs) per 1,000 person-years in those who were HCV-seronegative and HCV-seropositive were 3.3 (3.0-3.7) and 2.7 (2.2-3.3), respectively, and for those who were HBV-seronegative, had inactive infection or had active infection were 3.2 (2.8-3.5), 4.2 (3.1-5.2) and 2.8 (1.8-3.9), respectively. After adjustment, there was no association between HCV seropositivity (rate ratio 0.86 [95% CI 0.62-1.19]), inactive HBV infection (rate ratio 1.07 [95% CI 0.79-1.43]) or active HBV infection (rate ratio 0.78 [95% CI 0.52-1.15]) and the development of myocardial infarction. CONCLUSIONS: We found no association between HBV or HCV coinfection and the development of myocardial infarction among HIV-infected individuals.

« Testaments de roys, princes et grands seigneurs, et homes doctes; testaments fictifs ». 1306 à 1669. Copies.

Contient : 1 « Testament de GUILLAUME LE HONGRE, chevalier de la ville de Metz... Ceste devise fust faitte devant feste S. Luc euvangeliste, quant il out a millair M.CCC.LIX ans » ; 2 « Testamentum GALESII DE BALMA, domini VALAFINI,... Actum et datum apud Montem Revellum, in castro nostro dicti loci, duodecima mensis augusti, hora meridiei, anno Domini millesimo trecentesimo sexagesimo secundo ». En latin ; 3 « Codicillus GALESII DE BALMA, domini VALAFINI ». Même date. En latin ; 4 « Testament de JEAN DE SAULZ, escuyer, seigneur DE COURTIVRON, chancelier de Bourgongne... Le mardy vint cinquiesme jour du mois de janvier, l'an de grace courant mille trois cent soixante et dix neuf » ; 5 « Testament de CATHERINE D'ESTRABONE, dame D'AUMONT ». Après 1456 ; 6 « Testament de Jean d'Arsonvalle, evesque de Chaalon. Tiré des registres du parlement de Paris ». 23 et 24 août 1416. En latin ; 7 « Testament de messire JEHAN DE CHALLON, prince D'ORENGE et seigneur D'ARLAY,... Faict et donné en mon chastel de Lyons le Saulnyer... le 21 d'octobre 1417... Extraict des registres de l'officialité de l'arcevesché de Bezançon » ; 8 Testament de « CLAUDE DE MONTAGU, chevalier, Sr DE COULCHES, DE LONGVY et D'ESPOISSE,... Le cinquiesme jour de... l'an mil IIII.C. cinquante et trois » ; 9 Extrait du testament de Pierre Berland, archevêque de Bordeaux. Samedi 5 février 1457. En latin ; 10 « Testamentum illustris comitis Troyae, Joannis Cossa, domini de Grimaldo et de Marignana, magni Provinciae senescalli ». Dimanche 15 septembre 1476. En latin ; 11 « Testament d'Olivier, seigneur de La Marche, conseiller et premier maistre d'hostel de Mr l'archiduc d'Austriche ». Bruxelles, 8 octobre 1501 ; 12 « Testament de PHILIPPE DE MONTAGU, comtesse DE JOIGNY » ; 13 « Testament de... Loys, Sr de Graville, admiral de France... Au chasteau de Marcoussys, l'an 1516, le jeudi 26 juing » ; 14 « Testamentum Claudii de Seyssel, archiepiscopi Taurinensis ». Turin, dimanche 27 mai 1520. En latin ; 15 Testament de « GUILLAUME BUDE, conseiller du roy, maistre des requestes ordinaire de son hostel, et maistre de sa librairie... 23 juin 1536 » ; 16 Testament de « Guillaume Du Bellay, seigneur de Langey et Glatigny,... lieutenant general en Italye... Turin, le 13 novembre 1542 » ; 17 « Testament de Michel Nostradamus,... docteur en medecine et astrophile de la ville de Salon... 17 juin 1566 » ; 18 « Testament de Caesar de Nostredame, gentilhomme ordinaire de la chambre du roy... Salon, 23 janvier 1630 » ; 19 Testament d'« ODINET GODRAN, baron D'ANTILLY, president au parlement de Bourgoigne ». 3 février 1581 ; 20 « Testament de JACQUELINE DE ROHAN, marquise DE ROTHELIN ». Décédée en 1586 ; 21 Testament de FRANÇOIS, duc D'ALENÇON, fils de Henri II, roi de France. Château-Thierry, 8 juin 1584 ; 22 Testament de « JEANNOT PATOILLET, protonotaire du S. Siege... demeurant à S. Ligier ». 22 juillet 1585 ; 23 Lettres de légitimation accordées par HENRI III, roi de France, à « Lune Patouillet, fille naturelle de Jeannot Patouillet et Jeanne Sailliot, du village d'Estrevaut, bailliage de Dijon... Donné à Dijon, au mois de febvrier, l'an 1575 » ; 24 à 26 Épitaphes d'«Odet Patoillet, d'Estrevaux », Richard Patoillet, et Jeannot Patoillet, le protonotaire. 1543, 1546, 1585. La première est en français, les deux autres sont en latin ; 27 Testament de « JAQUES DE GERMIGNY, Sr DE GERMOLLES, chevalier de l'ordre du roy, conseiller et maistre d'hostel ordinaire de sa maison, et cy devant ambassadeur pour S. M. en Levant », et de « JEHANNE BORLETTE, femme dud. Sr de Germigny,... Novembre 1585, en [la] ville de Chalon » ; 28 « Advis de conseil au proces de Mrs [Henri] de Vienne », baron de Chevreau, et François de Vienne, chevalier de Malte, « contre [Claude de La Baume], archevesque de Besançon ». Avant 1582. Commence par un extrait du testament de « dame JEHANNE DE MONBELIARD, [femme de] Loys de Chalon, prince d'Oranges et Sr d'Arlay » ; 29 Testament de « François, filz de feu Henry de Vienne, baron de Chevreaul,... Mostier, 25 octobre 1596 » ; 30 « Testamentum ROBERTI, cardinalis BELLARMINI,... Die 23 januarii, anno 1611 ». En latin ; 31 « Testament de FRANÇOIS PITHOU,... 20 novembre 1617 » ; 32 « Testament de PHILIPPE-GUILLAUME, prince D'ORANGE,... Faict à Bruxelles, le 20 de febvrier 1618 » ; 33 « Testament de messire GUILLAUME DU VAIR, evesque de Lizieux et garde des sceaux de France ». Du 10 juin au 5 juillet 1620 ; 34 « Testament de messire ANTHOINE FAVRE, baron de Peroges, de Domessin,... premier president au senat de Savoye... Faict à Chambery... ce 15 febvrier 1624 » ; 35 « Testamento di Leonor de Semeur, sigr de Tremon,... governatore per il re christianissimo di Francia della citta et paese di Macon di Bergongna... Nel... monasterio di molto reverendi padri capucini... sito sopra le fini d'Asti ». 14 juillet 1625. En italien ; 36 « Testament de Gabriel de Ste Marie, archevesque de Reims... Reims, 27 septembre 1628 » ; 37 « Exemplar testamenti cardinalis LUDOVISII ». Bologne, 10 avril 1629. En latin ; 38 « Testament de Nicolas Claude Fabri, seigneur de Peiresc, seigneur et abbé de Guistres, baron de Rians, conseiller du roy en sa cour de parlement de Provence... Aix, 22 juin 1637 » ; 39 Pièce imprimée, de 16 pages, contenant le « Testament de Mr le cardinal DE RICHELIEU ». Narbonne, 23 mai 1642 ; 40 « Testament d'ANNE DE MONTAFIE, comtesse DE SOISSONS,... Faict en mon chasteau de Creil, le 30 octobre 1642 » ; 41 « Premier testament de Gabriel de Syon,... prestre, docteur on theologie... et professeur royal... es langues orientales... Ligny le Chastel, 8 juin 1648 » ; 42 « Second Testament » du même. « Fontaine en Duesmois, 29 juin 1648 » ; 43 « Testament de CLAUDE DE SAUMAISE, chevalier de l'ordre du roy et conseiller en ses conseils d'Estat et privé... Spa, le 30 aoust 1653 » ; 44 Testament de « JEAN QUENAULT, conseiller du roy en ses conseils, et cy devant secretaire des commandemens de la feue reine Marie de Medicis,... Paris, 4 febvrier 1655 » ; 45 « Testament et codicille de Pierre Gassendi, prestre, prevost de Digne et professeur royal aux mathematiques à Paris ». 17 et 18 septembre 1655 ; 46 « Testament de Jules, cardinal Mazarin, duc de Nivernois et Donziois, pair de France ». Vincennes, 3 à 7 mars 1661 ; 47 « Testament d'Anne d'Autriche, royne de France et de Navarre... S. Germain en Laye, 13 aoust 1665 » ; 48 Pièce imprimée, de 6 pages, contenant le testament de « LOUIS DE LA RIVIERE, evesque de Langres... Petit Bourg, 22 may 1669 » ; 49 « Testamentum THEOPHILI VIAUT,... Datum in aula burgundica ». 1626. En latin ; 50 « Ejusdem epitaphium ». En latin ; 51 « Testamentum christianum cardinalis RICHELII ». En latin ; 52 « Testamentum politicum ». En latin ; 53 « Testamento della citta di Candia. Copia tratta da Pasquino, notaro publico ». En italien ; 54 « Testamento del Ruyseñor de Sa Eminencia ». En espagnol ; 55 « Epitaphio del Ruyseñor ». En espagnol