Increased circulating ANG II and TNF-α represents important risk factors in obese Saudi adults with hypertension irrespective of diabetic status and BMI

Central adiposity is a significant determinant of obesity-related hypertension risk, which may arise due to the pathogenic inflammatory nature of the abdominal fat depot. However, the influence of pro-inflammatory adipokines on blood pressure in the obese hypertensive phenotype has not been well established in Saudi subjects. As such, our study investigated whether inflammatory factors may represent useful biomarkers to delineate hypertension risk in a Saudi cohort with and without hypertension and/or diabetes mellitus type 2 (DMT2). Subjects were subdivided into four groups: healthy lean controls (age: 47.9±5.1 yr; BMI: 22.9±2.1 Kg/m2), non-hypertensive obese (age: 46.1±5.0 yr; BMI: 33.7±4.2 Kg/m2), hypertensive obese (age: 48.6±6.1 yr; BMI: 36.5±7.7 Kg/m2) and hypertensive obese with DMT2 (age: 50.8±6.0 yr; BMI: 35.3±6.7 Kg/m2). Anthropometric data were collected from all subjects and fasting blood samples were utilized for biochemical analysis. Serum angiotensin II (ANG II) levels were elevated in hypertensive obese (p<0.05) and hypertensive obese with DMT2 (p<0.001) compared with normotensive controls. Systolic blood pressure was positively associated with BMI (p<0.001), glucose (p<0.001), insulin (p<0.05), HOMA-IR (p<0.001), leptin (p<0.01), TNF-α (p<0.001) and ANG II (p<0.05). Associations between ANG II and TNF-α with systolic blood pressure remained significant after controlling for BMI. Additionally CRP (p<0.05), leptin (p<0.001) and leptin/adiponectin ratio (p<0.001) were also significantly associated with the hypertension phenotype. In conclusion our data suggests that circulating pro-inflammatory adipokines, particularly ANG II and, TNF-α, represent important factors associated with a hypertension phenotype and may directly contribute to predicting and exacerbating hypertension risk

Effectiveness of acupuncture, special dressings and simple, low-adherence dressings for healing venous leg ulcers in primary healthcare: study protocol for a cluster-randomized open-labeled trial

<p>Abstract</p> <p>Background</p> <p>Venous leg ulcers constitute a chronic recurring complaint that affects 1.0–1.3% of the adult population at some time in life, and which corresponds to approximately 75% of all chronic ulcers of the leg. Multilayer compression bandaging is, at present, the only treatment that has been proved to be effective in treating this type of ulcer. There is no consensus, however, about the dressings that may be applied, beneath the compression, to promote the healing of this type of ulcer, as there does not seem to be any added benefit from using special dressings rather than simple, low-adherence ones. As well as analgesia, acupuncture provokes peripheral vasodilation, in skin and muscles – which has been demonstrated both experimentally and in clinical practice – probably due to the axon reflex, among other mechanisms. The aim of the present study is to measure the effectiveness and cost of compression treatment for venous leg ulcers combined with special dressings, in comparison with low-adherence ones and acupuncture.</p> <p>Methods/design</p> <p>Cluster-randomized open-labeled trial, at 15 primary healthcare clinics in the Sevilla-Sur Healthcare District, with a control group treated with compression bandaging and low-adherence dressings; the experiment will consist, on the one hand, of the compression treatment applied in combination with special dressings (Treatment 1), and on the other, the compression treatment applied in association with low-adherence dressings, together with acupuncture (Treatment 2).</p> <p>Discussion</p> <p>The results will be measured and recorded in terms of the median time elapsed until complete healing of the ulcer, and the rate of complete healing at 3 months after beginning the treatment. An economic analysis will also be made.</p> <p>This study, carried out in the context of real clinical practice, will provide information for decision-taking concerning the effectiveness of special dressings. Moreover, for the first time a high-quality study will evaluate the effectiveness of acupuncture in the process of healing venous leg ulcers.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN26438275.</p

NOTAS E RESENHAS

COBERTURA VEGETAL, POLUIÇÃO AÉREA E DESLIZAMENTOS NA SERRA DO MAR – Helmut TROPPMAIR e Maria Eugênia M. C. FERREIRA. A ECONOMIA POLÍTICA DO COMPLEXO AGROINDUSTRIAL BRASILEIRO (Notas Básicas para Elaboração de um Programa de Pesquisa) - Geraldo MULLER SISTEMAS DA SUPERFÍCIE TERRESTRE - Antonio CHRISTOFOLETTI GEOMORFOLOGIA DINÂMICA, AMBIENTAL E PALEOECOLOGIA - Antonio CHRISTOFOLETTI ANÁLISE, MONITORIAMENTO E PREVISÃO EM HIDROLOGIA - Antonio CHRISTOFOLETTI ENSINO DA GEOGRAFIA - Antonio CHRISTOFOLETTI ATLAS NACIONAL DO BRASIL - REGIÃO NORDESTE - Miguel Cezar SANCHEZ INTRODUÇÃO À BIODETERIORAZÃO - Myrian Cecilia ROLIM PROCHNOW REFLORESTAMENTO E IMPACTOS AMBIENTAIS - Maria Juraci ZANI DOS SANTOS FORMA URBANA E A NOVA TECNOLOGIA - Pompeu FIGUEIREDO DE CARVALHO O CAPITAL FINANCEIRO E O MERCADO IMOBILIÁRIO DE ESCRITÓRIOS - Pompeu FIGUEIREDO DE CARVALHO O PODER DA BUROCRACIA – R. BATLEY DIALÉTICA DO CONCRETO - Aldomar Arnaldo RUCHERT INTELIGÊNCIA ARTIFICIAL - João Francisco DE ABREU SISTEMAS DE INFORMAÇÃO PARA PLANEJAMENTO REGIONAL - João Francisco DE ABREU ANÁLISE DOS FLUXOS DE MIGRAÇÃO - João Francisco DE ABREU MODELOS PROJETIVOS DA POPULAÇÃO REGIONAL - João Francisco DE ABREU REPRESENTAÇÃO GRÀFICA DAS INFORMAÇÕES QUANTITATIVAS - João Francisco DE ABREU A CULTURA DO ARROZ - Ana Tereza CACERES CORTEZ MORAES O OCEANO MIOCÊNICO - Reinaldo José BERTINI PROGRESS IN PHYSICAL AND IN HUMAN GEOGRAPHY 1985-1986 - Antonio CHRISTOFOLETTI CONCEITOS E TÉCNICAS EM GEOGRAFIA - Antonio CHRISTOFOLETTI GEOGRAFIA ECONÔMICA DA HÚNGRIA - Antonio CHRISTOFOLETTI PRAGAS E VENENOS: AGROTÓXICOS NO BRASIL E NO TERCEIRO MUNDO - Lígia Celoria POLTRONIÉRI O ESCÂNDALO DAS SEMENTES: O DOMÍNIO NA PRODUÇÃO DE ALIMENTOS - Lígia Celoria POLTRONIÉR

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when &gt;70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

The CLEAR (Considering Leading Experts’ Antithrombotic Regimes around peripheral angioplasty) survey:an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention

BACKGROUND: Antiplatelet and anticoagulant therapy are commonly used before, during and after peripheral arterial endovascular intervention. This survey aimed to establish antiplatelet and anticoagulant choice for peripheral arterial endovascular intervention in contemporary clinical practice. METHODS: Pilot-tested questionnaire distributed via collaborative research networks. RESULTS: One hundred and sixty-two complete responses were collected from responders in 22 countries, predominantly the UK (48%) and the rest of the European Union (44%). Antiplatelet monotherapy was the most common choice pre-procedurally (62%). In the UK, there was no difference between dual and single antiplatelet therapy use post procedure (50% vs. 37% p = 0.107). However, a significant majority of EU respondents used dual therapy (68% vs. 20% p < 0.001). There was variation in choice of antiplatelet therapy by the device used and the anatomical location of the intervention artery. The majority (82%) of respondents believed there was insufficient evidence to guide antithrombotic therapy after peripheral endovascular intervention and most (92%) would support a randomised trial. CONCLUSIONS: There is widespread variation in the use of antiplatelet therapy, especially post peripheral arterial endovascular intervention. Clinicians would support the development of a randomised trial comparing dual antiplatelet therapy with monotherapy