Endothelium modulates vasoconstrictor response to prostaglandin I2 in rat mesenteric resistance arteries: interaction between EP1 and TP receptors

BACKGROUND AND PURPOSE

Prostacyclin (PGI(2)) is usually described as an endothelium-derived vasodilator, but it can also induce vasoconstriction. We studied the vasomotor responses to PGI(2) in resistance arteries and the role of thromboxane (TP) and prostaglandin E(2) (EP) receptors in this effect.

EXPERIMENTAL APPROACH

Mesenteric resistance arteries were obtained from Sprague-Dawley rats. Vasomotion to PGI(2) was studied in segments of these arteries with and without endothelium and in presence of the nitric oxide (NO) synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME), the potassium channel blockers apamin plus charybdotoxin, the non-selective EP receptor antagonist AH6809, the selective TP receptor antagonist SQ29548 or the EP(1) receptor antagonist SC19220. PGI(2)-induced NO release was analysed in the absence or presence of SQ29548, AH6809 or SC19220.

KEY RESULTS

PGI(2) caused contractions in arterial segments that were increased by endothelium removal, L-NAME or L-NAME plus apamin plus charybdotoxin and abolished by SQ29548. In segments with endothelium, AH6809 or SC19220 almost abolished the contractions to PGI(2); this effect was prevented by L-NAME, L-NAME plus apamin plus charybdotoxin or by endothelium removal. PGI(2) induced NO release that was inhibited by the prostacyclin receptor (IP receptor) antagonist, RO1138452, and increased by SQ29548, SC19220 and AH6809. The increase in NO release induced by these separate drugs was inhibited by RO1138452.

CONCLUSIONS AND IMPLICATIONS

PGI(2) activated the TP receptor in mesenteric resistance arteries and produced vasoconstriction, which the endothelium modulated through TP and EP(1) receptors. PGI(2) also released endothelium-derived hyperpolarizing factor and, through IP receptor activation, induced NO release, which in turn, was antagonized by TP and EP(1) receptor activation.

[Attitude of the adult patient with atopic dermatitis to the disease and its treatment: the ACTIDA Study]

OBJECTIVE

To determine the attitude of adult patients with atopic dermatitis (AD) to their disease and its treatment.

MATERIAL AND METHODS

A multicenter, cross-sectional study was performed in patients with at least 2 outbreaks of AD in the previous year.

RESULTS

Two hundred twenty-seven dermatologists recruited 1441 analyzable patients, the majority women, with a mean of 3.6 outbreaks per year. Most of the patients (97.2%) indicated that they always or sometimes requested medical evaluation of a new outbreak. In the most recent outbreak, 72.2% had used combined therapy, regardless of the severity of the episode; 2-drug combinations were the most common. The majority of dermatologists prescribed combined therapy, most commonly a 2-drug combination for mild or minimal disease, and 3 or more drugs for moderate to very severe outbreaks.

CONCLUSIONS

Treatments used by patients for an outbreak of AD are similar to those prescribed by dermatologists in recent outbreaks.

Quality of life two years after radical prostatectomy, prostate brachytherapy or external beam radiotherapy for clinically localised prostate cancer: the Catalan Institute of Oncology/Bellvitge Hospital experience

OBJECTIVE

The objective was to compare the short- and long-term impact of 3 different treatment modalities on health-related quality of life (HRQOL) in patients treated for localised prostate cancer at a single centre in Catalonia, Spain.

MATERIAL AND METHODS

This was a longitudinal, prospective study of 304 patients from a single centre in Catalonia, Spain. Patients underwent 1 of 3 treatment procedures: radical prostatectomy (114 patients), external beam radiation (134) or interstitial brachytherapy (56). HRQOL was assessed by both general and specific questionnaires, including the SF-36 health survey and the Expanded Prostate Cancer Index Composite (EPIC). Interviews were administered prior to treatment and at months 1, 3, 6, 12 and 24. One-way analysis of variance and generalised estimating equations models were constructed to assess between group differences in HRQOL.

RESULTS

After initial deterioration, HRQOL scores partially recovered, although significant differences between treatment groups persisted at two years. Worsening of urinary incontinence was especially marked for the radical prostatectomy group (11.45, p=0.005), while deterioration in the urinary irritative/obstructive domain was worse following brachytherapy treatment (4.76, p=0.025). Decline in sexual function was significantly greater for the radical prostatectomy group than for the brachytherapy group (18.74, p<0.001). No significant between-group differences were observed in bowel domain scores.

CONCLUSIONS

Quality of life 2 years after treatment for prostate cancer shows wide variability. Radical prostatectomy had the largest negative impact on the sexual and urinary incontinence domains. Differences between external radiation and brachytherapy were relatively small. Brachytherapy led to a moderate increase in urinary irritation compared to the other 2 groups.

Treatment persistence and compliance with a combination of calcium and vitamin D

INTRODUCTION

The persistence and compliance of patients in Spain with calcium and vitamin D supplementation are unknown, and thus the purpose of the present study was to determine the current figures.

METHODS

This was a multicenter, cross-sectional study. Throughout Spain, 1342 primary-care physicians and specialists were asked to recruit 7888 patients aged 45 years or over, who had been prescribed with a calcium and vitamin D combination (CaVitD) at least 1 year prior to the study. Data on biodemographics, the reason for prescription and fracture risk factors were collected. Persistence with treatment, reasons for discontinuation, and compliance among persistent patients were assessed and patients' profiles analyzed.

RESULTS

From the recruited sample, a total of 7624 patients were finally analyzed. Most subjects were postmenopausal (mean age 65.7 ± 9.4 years). The main reason for CaVitD prescription was osteoporosis (56.3%), started 2-5 years earlier. A family history of osteoporosis (41.4%) and previous fractures (40.7%) occurred frequently in the patients' clinical histories. At the study visit, 27.7% had discontinued CaVitD treatment, the main reason being fatigue due to the long-term treatment. Just 31.2% of persistent patients were adherent. Non-persistent patients were more likely to be smokers, alcohol consumers, have a long immobilization history, malabsorption syndrome and previous bone fractures.

CONCLUSIONS

Only two in ten patients effectively comply with CaVitD treatment after 1 year or more of its prescription.

Respiratory impedance during weaning from mechanical ventilation in a mixed population of critically ill patients

BACKGROUND

Worsening of respiratory mechanics during a spontaneous breathing trial (SBT) has been traditionally associated with weaning failure, although this finding is based on studies with chronic obstructive pulmonary disease patients only. The aim of our study was to assess the course of respiratory impedance non-invasively measured by forced oscillation technique (FOT) during a successful and failed SBT in a mixed population.

METHODS

Thirty-four weaning trials were reported in 29 consecutive mechanically ventilated patients with different causes of initiation of ventilation. During the SBT, the patient was breathing through a conventional T-piece connected to the tracheal tube. FOT (5 Hz, +/- 1 cm H(2)O, 30 s) was applied at 5, 10, 15, 20, 25, and 30 min. Respiratory resistance (Rrs) and reactance (Xrs) were computed from pressure and flow measurements. The frequency to tidal volume ratio f/V(t) was obtained from the flow signal. At the end of the trial, patients were divided into two groups: SBT success and failure.

RESULTS

Mixed model analysis showed no significant differences in Rrs and Xrs over the course of the SBT, or between the success (n=16) and the failure (n=18) groups. In contrast, f/V(t) was significantly (P<0.001) higher in the failure group.

CONCLUSIONS

Worsening of respiratory impedance measured by FOT is not a common finding during a failed SBT in a typically heterogeneous intensive care unit population of mechanically ventilated patients.

Epidemiology, healthcare, resources, use and clinical features of different types of urticaria. Alergológica 2005

INTRODUCTION

In spite of the impact on quality of life, little attention has been given to chronic urticaria.

OBJECTIVE

To describe the morbidity and features of urticaria and compare the results with the other allergic diseases included in this study.

RESULTS

Urticaria is the fourth most prevalent condition after rhinitis, asthma and drug allergy. Despite this position, the number of patients who needed to visit emergency departments was higher (54.4%) than the rest of the sample (24.6%) (P < .001). The percentage of urticaria/angioedema patients with work absences was also higher than the rest of the sample suffering from other allergic conditions. We found significant differences in school performance between urticaria/angioedema children and children from of the rest of the sample (P = .029). Paired analysis identified significant differences in percentages of "bad school performance" for children suffering from urticaria/angioedema. Patients suffering from chronic urticaria scored in the lowest 25th percentile on physical impact. On psychological impact, urticaria patients scored below the 20th percentile of the general population. The general trend was to order extensive laboratory test for patients suffering from urticaria. In the present study, only one patient had a systemic disease, 13 patients had autoimmune and endocrine diseases often present with chronic urticaria. In spite of the insistence on the possible role of infections in chronic urticaria, in our study an infection could only be demonstrated in three patients.

CONCLUSION

Based on these results, we believe that urticaria is a disease with significant morbidity and involves heavy use of healthcare services and as such deserves more resources and attention.

From pollinosis to digestive allergy

Pollinosis is defined as the appearance of respiratory symptoms (rhinoconjunctivitis and/or asthma) as a result of the inhalation of pollen to which the individual is sensitized. Pollen allergy becomes all the more relevant on taking into account that it may be responsible for the development of plant food allergy, or may even constitute the direct cause of esophageal, gastric and/or intestinal inflammation in the context of a digestive allergic process. Pollen can act as a source of allergens that induce primary sensitization in the host as a result of inhalation, with secondary allergy to plant foods containing shared allergens via a cross-reactivity mechanism. The observed pattern of plant food allergy depends on the dietary habits of the population in a given geographical setting, and on the pollination found in that setting. Pollinosis may account for the greater or lesser prevalence of allergy to certain plant foods, and for the severity of the associated reactions. Beyond the digestive tract inflammation that may result from allergy to a given food, pollinosis is also intrinsically able to generate a clinically relevant or irrelevant Th2-mediated inflammatory response at digestive level, and may even give rise to eosinophilic esophagitis. Inter-relation with the airway may also extend to the digestive tract as a consequence of the systemic response that characterizes allergic disease.

Reference values for facilitating the interpretation of the ESPRINT-15 questionnaire (Spanish version)

OBJECTIVE

ESPRINT-15 is a specific, short-form instrument to measure health-related quality of life in adults suffering from allergic rhinitis. The aim of this study was to obtain reference values in order to improve its interpretability.

METHODS

ESPRINT-15 was administered to a representative sample of Spanish adults with allergic rhinitis. Means and percentiles were obtained, taking into account the kind of rhinitis (persistent/intermittent) and symptom severity (very mild/mild/moderate/severe).

RESULTS

A total of 2756 patients participated in the study. Mean (SD) scores were significantly lower (better) for men than for women (2.2 [1.4] vs 2.4 [1.4], P<.001, effect size [ES] is congruent to 0.15). Patients with intermittent rhinitis showed better scores than patients with persistent rhinitis (2.1 [1.4] vs. 2.5 [1.4], P<.001, ES is congruent to 0.21). Mean (SD) scores were higher (worse) when severity of symptoms increased, ranging from 0.9 (0.9) (very mild) to 3.7 (1.0) (severe) (ES is congruent to 1.0 between each consecutive group of symptom severity).

CONCLUSIONS

The magnitude of the differences found among groups of patients reinforces the usefulness of providing reference values stratified by gender, type of allergic rhinitis, and symptom severity. The percentiles obtained can be used in clinical practice to evaluate individual scores, and assign the patient to the corresponding reference group.