GheOP3 S tool and START/STOPP criteria version 2 for screening of potentially inappropriate medications and omissions in nursing home residents

RATIONALE, AIMS, AND OBJECTIVE

There is limited information about the comparative effectiveness of the START/STOPP (Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment) criteria and the Ghent Older People's Prescriptions community Pharmacy Screening tool (GheOP³ S tool) for the screening of potentially inappropriate prescribing (PIP) in the geriatric population. Considering this, the aim of this study was to compare the ability of the START/STOPP criteria and GheOP³ S tool to identify the PIP and potential prescribing omissions (PPOs) among elderly patients visiting their primary care physician.

METHODS

This is a retrospective observational study where a total of 422 subjects were included. The Charlson Co-morbidity Index (CCI) and the Medicines Co-morbidity Index (MCI) for older people were used to determine the co-morbidity status. The user's diagnosis and medications prescribed were analysed with the START/STOPP criteria and GheOP³ S tool. The Wilcoxon signed rank test was used to compare these criteria. The statistical relationship between the occurrence of PIP and users' age, the number of medication prescribed, the number of diagnoses, CCI, and MCI was determined with one-tailed bivariate correlation.

RESULTS

The START/STOPP criteria detected 843 PIPs and 1067 PPOs, while the GheOP³ S tool detected 936 PIPs and 202 PPOs. The GheOP³ S tool detected significantly more PIPs than did the STOPP criteria (P = 0.003). A significantly higher number of PPOs were detected with the START criterion (P < 0.0001). The results obtained with the START/STOPP criteria positively correlated with mentioned variables. Oppositely, there is a negative correlation between the results obtained with the GheOP³ S tool and age. Still, the positive correlation could be found with the rest of the variables.

CONCLUSION

The results of this study indicate that both tested tools demonstrated efficiency to detect PIPs and PPOs. The GheOP³ S tool detected significantly more PIPs than did the STOPP criteria. On the other hand, the START criteria performed much better for the screening of PPOs.

Potentially Inappropriate Medications in Belgrade, Serbia Nursing Home Residents: A Comparison of Two Approaches

There is currently limited information on the comparative effectiveness of the European Union(7)-potentially inappropriate medication (EU(7)-PIM) list and the Beers criteria for screening PIMs, of which PIMs are a significant concern, in the geriatric population of nursing home residents. This study aims to determine and compare the rates of PIMs detected with the Beers criteria (five sections of which the first is a list of inappropriate medications in older adults) and the EU(7)-PIM list (based on the first section of the Beers criteria). The study, conducted in Gerontology Center Belgrade (n = 427), is retrospective and observational. The EU(7)-PIM list detected 876 PIMs, while the first section of the Beers criteria detected 782 PIMs (1,803 with all five sections). The majority of PIMs belong to psychotropic drugs (benzodiazepines being the most common). The EU(7)-PIM list detected significantly more PIMs than the first section of the Beers criteria (2.03 ± 1.63 vs. 1.83 ± 1.27; p = .0005). The number of detected PIMs with both criteria correlates with age, the number of chronic illnesses, the number of medication prescribed, and the comorbidity status. Ultimately, the EU(7)-PIM list detected more PIMs compared to the first section of the Beers criterion.

Use of soil enzyme activities to assess the recovery of soil functions in abandoned coppice forest systems

Coppicing consists of periodically cutting back tree stems to ground level to stimulate the growth of multiple stems from the stool. In Central Europe, many coppiced forests were abandoned at the beginning of the last century owing to a decline in the demand for charcoal and wood. This was assumed to enable the forests to recover and the properties to become similar to those of unmanaged forest (high forest). Most studies on abandoned coppiced forest have focused on forest recovery, while soil recovery has generally been overlooked. With the aim of filling this gap, this study investigated the effect of coppicing abandonment on soil recovery by analysing the changes in soil enzyme activities (dehydrogenase, β-glucosidase, invertase, urease, acid phosphatase and arylsulphatase). Two differently managed sessile oak (Quercus petraea) forests were selected for study: a former coppice forest, abandoned >90 years ago, and an undisturbed forest. The analytical data were compared to assess the degree of recovery of the soil in the abandoned coppice forest. The soil organic matter content was two times lower in the abandoned coppice than in the high forest, suggesting that organic matter depletion due the past coppicing is a long-term effect. All of the absolute enzyme activities were also two times lower in the abandoned coppice forest soil than in the high forest soil. However, the specific enzyme activities were similar in both types of soil. This indicates that metabolic activity is similar in both soil types, suggesting that it either recovers faster than organic matter and soil enzyme activity or that, despite the depletion in organic matter and enzyme activities, metabolic activity was sustained in coppiced forest soil. However, in the latter case this would imply that organic matter and soil enzymes were lost in exactly the same proportion, which is highly improbable.

Calcium Channel Blockers in Restoration of Endothelial Function: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Clinical evaluation of the Endothelial Function (EF) is becoming an essential step in the quality assessment of cardiovascular risk prevention and rational pharmacotherapy of cardiovascular disorders. The existing pieces of evidence suggested that Calcium Channel Blockers (CCB) can induce positive effects on impaired EF.

OBJECTIVE

To evaluate the effects of CCB on EF, we performed a meta-analysis of available data from randomized and placebo-controlled or other treatment-controlled clinical studies encompassing effects of CCB on EF, as measured by Flow-Mediated Dilation (FMD) of the brachial artery.

METHODS

The relevant clinical studies were searched by systematic exploration of the appropriate databases until November 30, 2017. A random-effect model was conducted. The primary outcome was the percentage change in FMD between the baseline and the final levels in response to investigated drugs.

RESULTS

Fifteen randomized clinical studies with 33 arms were identified. CCB improved FMD more pronounced than thiazide diuretics - TD (3 studies, 157 participants, WMD=2.08%, 95% CI=0.35-3.80%; P=0.02). Oppositely, ACE Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) notably improved FMD if compared to CCB (CCB vs. ACEI: 5 studies, 533 participants, WMD = -1.62%, 95% CI = -2.74% to -0.50%; P=0.005; and CCB vs. ARB: 9 studies, 669 participants, WMD = -1.52%, 95% CI = -2.22% to -0.81%; P=0.0001). CCB effects on EF were similar to those evoked by beta blockers or placebo.

CONCLUSION

CCB improved EF to a more prominent extent only if paralleled to TD, while inversely; ACEI and ARB were more effective in augmenting FMD.

Anthocyanins Protect Hepatocytes against CCl4-Induced Acute Liver Injury in Rats by Inhibiting Pro-inflammatory mediators, Polyamine Catabolism, Lipocalin-2, and Excessive Proliferation of Kupffer Cells

: This study examined the hepatoprotective and anti-inflammatory effects of anthocyanins from Vaccinim myrtillus (bilberry) fruit extract on the acute liver failure caused by carbon tetrachloride-CCl₄ (3 mL/kg, i.p.). The preventive treatment of the bilberry extract (200 mg anthocyanins/kg, orally, 7 days) prior to the exposure to the CCl₄ resulted in an evident decrease in markers of liver damage (glutamate dehydrogenase, sorbitol dehydrogenase, malate dehydrogenase), and reduced pro-oxidative (conjugated dienes, lipid hydroperoxide, thiobarbituric acid reactive substances, advanced oxidation protein products, NADPH oxidase, hydrogen peroxide, oxidized glutathione), and pro-inflammatory markers (tumor necrosis factor-alpha, interleukin-6, nitrite, myeloperoxidase, inducible nitric oxide synthase, cyclooxygenase-2, CD68, lipocalin-2), and also caused a significant decrease in the dissipation of the liver antioxidative defence capacities (reduced glutathione, glutathione S-transferase, and quinone reductase) in comparison to the results detected in the animals treated with CCl₄ exclusively. The administration of the anthocyanins prevented the arginine metabolism's diversion towards the citrulline, decreased the catabolism of polyamines (the activity of putrescine oxidase and spermine oxidase), and significantly reduced the excessive activation and hyperplasia of the Kupffer cells. There was also an absence of necrosis, in regard to the toxic effect of CCl₄ alone. The hepatoprotective mechanisms of bilberry extract are based on the inhibition of pro-oxidative mediators, strong anti-inflammatory properties, inducing of hepatic phase II antioxidant enzymes (glutathione S-transferase, quinone reductase) and reduced glutathione, hypoplasia of Kupffer cells, and a decrease in the catabolism of polyamines.

Protective effects of anthocyanins from bilberry extract in rats exposed to nephrotoxic effects of carbon tetrachloride

This study examined the nephroprotective effects of 15 different anthocyanins from the bilberry extract on the acute kidney injury caused by CCl₄. The acute nephrotoxicity in rats was induced 24 h after the treatment with a single dose of CCl₄ (3 mL/kg, i.p.).The nephroprotective effects of the anthocyanins were examined in the animals that had been given the bilberry extract in a single dose of 200 mg of anthocyanins/kg daily, 7 days orally, while on the seventh day, 3 h after the last dose of anthocyanins, the animals received a single dose of CCl₄ (3 mL/kg, i.p.) and were sacrificed 24 h later. When the nephrotoxicant alone was administered, it resulted in a substantial increase of the pro-oxidative (TBARS, CD, H₂O₂, XO, and GSSG) and pro-inflammatory markers (TNF-α, NO, and MPO), as well as a noticeable reduction of the antioxidant enzymes (CAT, SOD, POD, GPx, GST, GR) and GSH when compared to the results of the control group. Moreover, the application of CCl₄ significantly influenced a reduction of the renal function, as well as an increase in the sensitive and specific injury indicators of the kidney epithelial cells (β₂-microglobulin, NGAL, KIM1/TIM1) in the serum and urine of rats. The pretreatment of the animals poisoned with CCl₄ with the anthocyanins from the bilberry extract led to a noticeable reduction in the pro-oxidative and pro-inflammatory markers with reduced consumption of the antioxidant defence kidney capacity, compared to the animals exposed to CCl₄ alone. Anthocyanins have been protective for the kidney parenchyma, with an apparent absence of the tubular and periglomerular necrosis, severe degenerative changes, inflammatory mononuclear infiltrates and dilatation of proximal and distal tubules, in contrast to the CCl₄-intoxicated animals. The nephroprotective effects of anthocyanins can be explained by strong antioxidant and anti-inflammatory effects achieved through the stabilization and neutralization of highly reactive and unstable toxic CCl₄ metabolites.

The enhancement of serotonin-induced contraction of rat femoral artery is mediated by angiotensin II release from intact endothelium

We have performed an in vitro study on isolated intact or denuded femoral artery (FA) of healthy, diabetic, and/or rats submitted to the FA occlusion. The aim was to determine the contribution of endothelium and endothelial dysfunction (ED) on serotonin-induced action in FA. Further, the contribution of angiotensin II and cyclooxygenase products of arachidonic acid was investigated. A marker of ED, vWF was measured in animal serum. Serotonin induced contraction-dependent contraction of isolated FA, which was increased in preparations with endothelium. Pathological conditions such as endothelial denudation, nicotine-induced ED, diabetes or occlusion of FA reduced serotonin-induced contraction. Comparable reduction of serotonin-induced contraction was achieved after inhibition of AT1 receptors with losartan in isolated FA with intact endothelium. Our results demonstrate that angiotensin II contributes to the enhancement of serotonin-induced contraction of femoral arteries with intact endothelium. This increase is attenuated by endothelium removal, nicotine treatment, vascular occlusion, and/or hyperglycemia.

The effect of rapid weight loss on body composition and circulating markers of creatine metabolism in judokas

We evaluated the effects of a 7-day rapid weight loss (RWL) intervention on body composition and biomarkers of creatine metabolism in eight elite judokas during a pre-competition period. RWL induced a significant drop in weight (81.7±10.7 kg at baseline vs. 76.8 ± 10.3 kg at follow-up; p&lt;.001), fat mass (12.6±5.6 kg vs. 9.2±4.0 kg; p=.003) and fat-free mass (69.1±7.3 kg vs. 67.6±7.7 kg; p=.05), accompanied by an increase in serum creatinine levels at follow-up (104.0±10.5 µmol/L vs. 114.9±10.2 µmol/L; p=.009). An acute restriction of food and fluid intake appears to negatively affect fat-free mass and indices of kidney function in judokas.

Effect of Adequacy of Dialysis and Nutrition on Morbidity and Working Rehabilitation of Patients Treated by Maintenance Hemodialysis

Numerous studies have demonstrated a correlation between adequacy of hemodialysis (HD) and patient mortality. In this study we evaluated the effect of adequacy of dialysis and nutrition on morbidity and working rehabilitation. Single center experience carried out in 1998 in an outpatient university-affiliated dialysis facility was presented. A total of 181 patients, on HD over 3 months, was included in the study; mean age 54.5 years, mean duration of HD 5.4 years. Thirthy-two patients were hospitalized in 1998. Patients with an eKt/V < 0.8 had significantly more frequent and extended hospitalizations than patients with eKt/V > 1.2. In the regression model eKt/V had a significant effect on hospital days. Serum albumin, as an index of nutrition, was also found to significantly influence hospitalizations. Patients with a BMI < 20.0 kg/m2 were found to have significantly more frequent hospitalizations, more hospital days/patient, and hospital days/hospitalized patient/year than those with a BMI > 25.0 kg/m2. BMI < 20.0 kg/m2 was associated with a significantly lower dialysis adequacy (eKt/V and URR) and more severe anemia. However, regression model failed to confirm a statistically significant association of BMI with hospital days. The best working rehabilitation (stage 1), according to the EDTA criteria, was obtained in patients with significantly (p<0.05) higher eKt/V, URR, albumin, nPNA, and body fat than in patients at stage 6 (not able to work, and not able to take care of themselves).

This study has established that dialysis adequacy and nutrition have an effect on morbidity (estimated through hospitalizations) and patient rehabilitation. (Int J Artif Organs 2000; 23: 83–9)

Prevention of Nosocomial Transmission of Hepatitis C Infection in a Hemodialysis Unit. A Prospective Study

Hepatitis C virus (HCV) infection in hemodialysis patients can be transmitted by transfusions and nosocomially. A high prevalence of HCV infection, over 50%, was demonstrated in our hemodialysis (HD) unit. In order to prevent the nosocomial spread of HCV infection in the HD unit a prospective study was begun separating anti-HCV positive patients from the negative ones. A total of 170 patients (83 anti-HCV positive) started this study in September 1994 and were followed for 4 years. A separate room and dedicated equipment were assigned to anti-HCV positive and anti-HCV negative patients. Of those 170 patients there were 15 hepatitis B virus (HBV) positive patients, 5 of whom were anti-HCV positive, who were treated in a separate room on dialysis equipment for anti-HCV positive or negative patients. Application of general precautions, as recommended by the Center for Disease Control and Prevention (CDC), was reinforced. During the first 12 weeks after implementing the precautions seven more anti-HCV positive patients were detected, and by December 1995 another two HCV infected patients were found. The follow-up included all changes in HD population treated until the end of 1998. The incidence of seroconversion to HCV was 12.9% in 1995, 7.1% in 1996, 5.0% in 1997, and 6.6% in 1998. The higher incidence of seroconversion in September to November 1994 was probably due to the nosocomial infection being in the incubation period at the time of isolation.

This prospective study in a large HD unit with a high prevalence of HCV infection demonstrates a relatively successful prevention of HCV spread. Procedure-related transmission of HCV in hemodialysis could be prevented by rigorous application of universal precautions as recommended by the CDC. As a second line of prevention, in highly burdened dialysis centers, segregation of HCV positive patients can help control nosocomial transmission.

Toxicity evaluation of two polyoxotungstates with anti-acetylcholinesterase activity

A toxicity evaluation of two Keggin-type heteropolytungstates, K₇[Ti₂PW₁₀O₄₀]·6H₂O and K₆H[SiV₃W₉O₄₀]·3H₂O, with different inhibitory potencies toward acetylcholinesterase activity (IC₅₀ values of 1.04×10^-6 and 4.80×10^-4mol/L, respectively) was performed. Wistar albino rats were orally treated with single doses (5 and 50mg/kg) of both investigated compounds. The biochemical parameters of renal (serum urea and creatinine) and liver function (direct and total bilirubin, alanine transaminase, and aspartate aminotransferase) were determined after 24h and 14days. A histopathological analysis of liver tissue was carried out 14days after the polyoxotungstate administration. Both applied doses of the investigated compounds did not induce statistically significant alterations of the renal function markers. However, the polyoxotungstate treatment caused an increase in the activities of serum alanine transaminase and aspartate aminotransferase in a time- and concentration-dependent manner, although statistically significant changes in bilirubin concentrations were not observed. Furthermore, the detected hepatotoxic effect was confirmed by histhopathological analysis that suggested some reversible liver tissue damage two weeks after the treatment, especially in the case of K₆H[SiV₃W₉O₄₀]·3H₂O. Accordingly, the toxicity of these two polyoxotungstates with anti-acetylcholinesterase effect cannot be considered as a severe one, but their potential clinical application would require a more complex toxicological study.

All that glitters on PET is not cancer! 18F-deoxy-glucose avidity versus tumor biology: pituitary incidentaloma in a survivor of two previous unrelated malignancies

INTRODUCTION

18F-deoxy-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) is routinely used in the detection of malignant disease based on the property of malignant cells to fuel their growth and replication by increased glucose uptake. Malignant lesions are rare in the sellar region, while pituitary adenomas are the most common pathology. These are benign neoplasms with insidious onset and low proliferation activity, and therefore are only exceptionally detected by 18F-FDG PET/CT. Studies that compare the biology of pituitary adenomas and their radiological properties using PET/CT are still lacking.

CASE REPORT

We investigate and discuss tumour biology in light of increased 18F-FDG avidity in a symptom-free, 70-year-old male patient, previously treated for two different malignancies (lung and rectal). Increased tracer accumulation in the sellar region was incidentally detected on a follow-up 18F-FDG PET/CT scan. Additional MRI disclosed pituitary adenoma. Normal hormonal status was found, consistent with the diagnosis of non-functioning pituitary adenoma. Analysis of tumour tissue after pituitary surgery confirmed a silent gonadotroph adenoma with low proliferation index. Low expression of oncogene-induced senescence markers did not support senescence as the explanation for the tumour's low proliferative activity although it was in consonance with the hormonal activity.

CONCLUSIONS

Pituitary adenomas can manifest as hypermetabolic foci on 18F-FDG PET/CT imaging with increased tracer uptake even in indolent, clinically silent pituitary adenomas with low mitotic activity. Special attention should be paid to evaluation of 18F-FDG avid pituitary adenomas in patients with multiple malignancies, bearing in mind that avidity does not always mirror its biological behaviour.

Angiotensin receptor blockers & endothelial dysfunction: Possible correlation & therapeutic implications

The endothelium is one of the most important constituents of vascular homeostasis, which is achieved through continual and balanced production of different relaxing and contractile factors. When there is a pathological disturbance in release of these products, endothelial dysfunction (ED) will probably occur. ED is considered to be the initial step in the development of atherosclerosis. This pathological activation and inadequate functioning of endothelial cells was shown to be to some extent a reversible process, which all together resulted in increased interest in investigation of different beneficial treatment options. To this point, the pharmacological approach, including for example, the use of angiotensin-converting enzyme inhibitors or statins, was clearly shown to be effective in the improvement of ED. One of many critical issues underlying ED represents instability in the balance between nitric oxide and angiotensin II (Ang II) production. Considering that Ang II was confirmed to be important for the development of ED, the aim of this review article was to summarize the findings of up to date clinical studies associated with therapeutic application of angiotensin receptor blockers and improvement in ED. In addition, it was of interest to review the pleiotropic actions of angiotensin receptor blockers linked to the improvement of ED. The prospective, randomized, double-blind, placebo or active-controlled clinical trials were identified and selected for the final evaluation.

Clarification of serotonin-induced effects in peripheral artery disease observed through the femoral artery response in models of diabetes and vascular occlusion: The role of calcium ions

Recent findings have demonstrated that serotonin is an important participant in the development and progression of peripheral artery diseases. Taking this into consideration, the goals of this study were to investigate the effects of serotonin on isolated Wistar rat femoral arteries in both healthy and diabetic animals, with and without artery occlusion, with a particular focus on determining the role of calcium in this process. Contraction experiments with serotonin on intact and denuded femoral artery rings, in the presence or absence of nifedipine and ouabain (both separately, or in combination), as well as Ca²⁺ -free Krebs-Ringer bicarbonate solution were performed. The serotonin-induced results were concentration dependent, but only in healthy animals. The endothelium-dependent contraction of the femoral artery was assessed. In healthy animals, the endothelium-reliant part of contraction was dependent on the extracellular calcium, while the smooth muscle-related part was instead dependent on the intracellular calcium. In diabetic animals, both nifedipine and ouabain influenced serotonin-induced vascular effects by blocking intracellular calcium pathways. However, this was diminished after the simultaneous administration of both blockers.

Combined Administration of Ghrelin and Corticotropin-Releasing Hormone in the Diagnosis of Cushing's Disease

BACKGROUND/AIMS

Exaggerated adrenocorticotropic hormone (ACTH) and cortisol responses to ghrelin in Cushing's disease (CD) have previously been reported, similarly to responses to corticotropin-releasing hormone (CRH). We assessed the ability of ghrelin to enhance ACTH and cortisol responses when added to CRH stimulation in CD patients.

METHODS

In 21 CD patients (18 females, 3 males; age 49.8 ± 10.2 years; BMI 29.8 ± 0.8) and 8 healthy subjects (7 females, 1 male; age 40.6 ± 5.3 years; BMI 29.9 ± 1.2), we administered (1) ghrelin 100 µg i.v. bolus, (2) CRH 100 µg i.v. bolus, and (3) ghrelin + CRH combination. ACTH and cortisol were analyzed by commercially available kits from samples taken at 0, 15, 30, 45, 60, 90 and 120 min. ACTH and cortisol responses were calculated as peak and area under the curve (AUC0-120 min).

RESULTS

ACTH and cortisol at baseline and stimulated with ghrelin and/or CRH (peak and AUC0-120 min) were significantly higher in CD patients compared to controls (p < 0.01). ACTH and cortisol responses to ghrelin or CRH were similar in CD patients. Combined ghrelin + CRH administration in CD patients produced the highest ACTH response (peak and AUC0-120 min) compared to ghrelin or CRH alone (p < 0.01). Cortisol responses after ghrelin + CRH were uncoupled with ACTH responses and similar to the response to ghrelin or CRH alone in both groups. ACTH and cortisol responses, during all three tests, were similar in CD patients with micro- or macroadenomas.

CONCLUSION

Ghrelin administration causes exaggerated ACTH and cortisol responses in CD patients compared to healthy controls. In combination with CRH, it additionally enhances ACTH secretion without further additive effect on cortisol output.

Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

There are only a few published studies related to the population-based etiology of hypopituitarism. New risks for developing hypopituitarism have been recognized in the last 10 years. Aim. To present data regarding the etiology of hypopituitarism collected in a tertiary center over the last decade. This is a cross-sectional database study. Patients and Methods. We included 512 patients (pts) with hypopituitarism, with a mean age of 45.9 ± 1.7 yrs (range: 18-82; male: 57.9%). Results. Nonfunctional pituitary adenomas were presented in 205 pts (40.5%), congenital causes in 74 pts (14.6%), while acromegaly and prolactinomas were presented in 37 (7.2%) and 36 (7.0%) patients, respectively. Craniopharyngiomas were detected in 30 pts (5.9%), and head trauma due to trauma brain injury-TBI and subarachnoid hemorrhage-SAH in 27 pts (5.4%). Survivors of hemorrhagic fever with renal syndrome (HFRS) and those with previous cranial irradiation were presented in the same frequency (18 pts, 3.5% each). Conclusion. The most common causes of hypopituitarism in our database are pituitary adenomas. Increased awareness of the other causes of pituitary dysfunction, such as congenital, head trauma, extrapituitary cranial irradiation, and infections, is the reason for a higher frequency of these etiologies of hypopituitarism in the presented database.

Vitamin D versus placebo in improvement of endothelial dysfunction: a meta-analysis of randomized clinical trials

AIMS

The possible effect of vitamin D administration in humans on endothelial dysfunction (ED) still remains undetermined. The current meta-analysis was performed to evaluate if vitamin D could improve ED.

METHODS

Randomized, double-blind, and placebo-controlled clinical trials were identified by systematic search of the PubMed, the Cochrane Library, the Web of Science and the Scopus data bases, as well as different reviews and clinical trials articles. A random effects model was used to calculate the pooled overall effect on flow-mediated dilation (FMD) linked to the vitamin D administration. Meta-regression and subgroup analyses were performed to evaluate the impact of study characteristics on the effect of vitamin D administration on FMD.

RESULTS

A total of eight studies with nine relevant study arms were identified. The obtained results of pooled analysis showed that vitamin D administration did not improve FMD (eight studies, 529 subjects; weighted mean difference (WMD): 0.96%, 95% CI: -1.24% to 2.06%; P = 0.09). This was probably due to significant heterogeneity in between included trials (I(2) = 84%, P < 0.00001). On the other hand, subgroup analysis demonstrated that vitamin D improved FMD in trials that lasted <16 weeks; if systolic blood pressure (SBP) was higher than 140 mmHg and in trials where diastolic blood pressure (DBP) was <80 mmHg.

CONCLUSION

Although the current evidence clearly demonstrates that in certain conditions vitamin D can improve ED, a larger number of clinical trials are needed to confirm this assumption to confirm or reject the final statement on this topic.

Thiazolidinediones improve flow-mediated dilation: a meta-analysis of randomized clinical trials

AIMS

Thiazolidinediones administration is assumed to be related with an improvement of endothelial dysfunction (ED); nevertheless, previous studies have been inconsistent. For this reason, the present meta-analysis was directed to estimate if thiazolidinediones were related to endothelial dysfunction improvement by using flow-mediated dilation (FMD) measurement.

METHODS

Literature search of the PubMed, the Cochrane Library, the Web of Science, and the Scopus databases was performed covering the period until July 01, 2015, for randomized clinical trials that investigated an influence of thiazolidinediones on FMD. For the calculation of the pooled overall effect, a random effect model was used. Meta-regression and subgroup analyses were performed to evaluate the impact of study characteristics on the effect of thiazolidinediones administration on FMD.

RESULTS

This meta-analysis included 16 studies with 812 subjects. The obtained results demonstrated an improvement of endothelial dysfunction measured with FMD (16 studies, 812 subjects; WMD: 2.4 %, 95 % CI = 1.1 to 3.69 %; p = 0.0003). The significant heterogeneity was noted (I (2) = 95 %, p < 0.00001). Subgroup analysis demonstrated that pioglitazone and rosiglitazone were able to improve FMD. Also, thiazolidinediones improved FMD if treatment was longer than 12 weeks and if patients were younger than 65 years. Additionally, a lipid profile was found to influence thiazolidinediones effect on FMD.

CONCLUSION

The results of this meta-analysis demonstrated that thiazolidinediones were able to improve FMD, which in clinical terms can be further translated to the improvement of an impaired endothelial function. Nevertheless, the link between FMD and its predictive clinical relevance still requires further clarification.

Experimental diabetes induced by alloxan and streptozotocin: The current state of the art

Diabetes mellitus is a chronic metabolic disorder with a high prevalence worldwide. Animal models of diabetes represent an important tool in diabetes investigation that helps us to avoid unnecessary and ethically challenging studies in human subjects, as well as to obtain a comprehensive scientific viewpoint of this disease. Although there are several methods through which diabetes can be induced, chemical methods of alloxan- and streptozotocin-induced diabetes represent the most important and highly preferable experimental models for this pathological condition. Therefore, the aim of this article was to review the current knowledge related to quoted models of diabetes, including to this point available information about mechanism of action, particular time- and dose-dependent protocols, frequent problems, as well as major limitations linked to laboratory application of alloxan and sterptozotocin in inducing diabetes. Given that diabetes is known to be closely associated with serious health consequences it is of fundamental importance that current animal models for induction of diabetes should be continuously upgraded in order to improve overall prevention, diagnosis and treatment of this pathological condition.