Efficacy and safety of mesh non-fixation in patients undergoing laparo-endoscopic repair of groin hernia: a systematic review and meta-analysis

PURPOSE

To examine updated evidence on the efficacy and safety of mesh non-fixation in patients undergoing laparo-endoscopic repair of groin hernias.

METHODS

We searched MEDLINE, Cochrane Central Library, Embase, ClinicalTrials. gov, and ICTRP databases to identify randomized controlled trials. The primary outcomes were recurrence, chronic pain, and return to daily life. The certainty of evidence (CoE) was assessed by grading recommendations, assessments, developments, and evaluations. We performed a subgroup analysis based on the surgical type. This study was registered with PROSPERO (CRD 42022368929).

RESULTS

We included 25 trials with 3,668 patients (4,038 hernias) were included. Mesh non-fixation resulted in little to no difference in hernia recurrence (relative risk [RR]:1.40, 95% confidence interval [CI]:0.59-3.31; I2 = 0%; moderate CoE) and chronic pain (RR:0.48, 95% CI:0.13-1.78; I2 = 77%; moderate CoE), but reduced return to daily life (mean difference [MD]: - 1.79 days, 95% CI: - 2.79 to -0.80; I2 = 96%; low CoE). In subgroup analyses, the transabdominal preperitoneal approach (TAPP) (MD: - 2.97 days, 95% CI: - 4.87 to - 1.08; I2 = 97%) reduced return to daily life than total extraperitoneal inguinal approach (MD: - 0.24 days, 95% CI - 0.71 to 0.24; I2 = 61%) (p = 0.006).

CONCLUSIONS

Mesh nonfixation improves the return to daily life without increasing the risk of hernia recurrence or chronic pain. Surgeons and patients may discuss mesh nonfixation options to accommodate a patient's desired return to daily life. Further trials focusing on TAPP are required to confirm these findings.

GINGER: an integrated method for high-accuracy prediction of gene structure in higher eukaryotes at the gene and exon level

The prediction of gene structure within the genome sequence is the starting point of genome analysis, and its accuracy has a significant impact on the quality of subsequent analyses. Gene structure prediction is roughly divided into RNA-Seq-based methods, ab initio-based methods, homology-based methods, and the integration of individual prediction methods. Integrated methods are mainstream in recent genome projects because they improve prediction accuracy by combining or taking the best individual prediction findings; however, adequate prediction accuracy for eukaryotic species has not yet been achieved. Therefore, we developed an integrated tool, GINGER, that solves various issues related to gene structure prediction in higher eukaryotes. By handling artefacts in alignments of RNA and protein sequences, reconstructing gene structures via dynamic programming with appropriately weighted and scored exon/intron/intergenic regions, and applying different prediction processes and filtering criteria to multi-exon and single-exon genes, we achieved a significant improvement in accuracy compared to the existing integration methods. The feature of GINGER is its high prediction accuracy at the gene and exon levels, which is pronounced for species with more complex gene architectures. GINGER is implemented using Nextflow, which allows for the efficient and effective use of computing resources.

Polarity and Dielectric Property Control Triggered by a Coordinated Solvent Molecule Exchange in Luminescent Mononuclear Aluminium(III) Complexes

The development of molecule-based multifunctional switchable materials, exhibiting a switch of polarity and dielectric property, are extremely limited. Herein, we demonstrated solvent-vapour-induced reversible molecular rearrangements between non-polar crystals [Al(sap)(acac)(sol)] (H2sap = 2-salicylideneaminophenol, acac = acetylacetonate, sol = MeOH (1), EtOH (2)) and polar crystal [Al(sap)(acac)(DMSO)] (3). This crystal-to-crystal structural transformation was accompanied by a switch of second harmonic generation (SHG) and dielectric properties, including the formation of ferroelectric domains, reflecting the SHG-active polar Cc space group of 3. This is the first reported example of dielectric properties and polarity switching in luminescent mononuclear aluminium(III) complexes, which exhibit the strong green emission in the solid state.

Mechanism of high photoluminescence quantum yield of melem

To produce high-efficiency organic light-emitting diodes, materials that exhibit thermally activated delayed fluorescence (TADF) are attracting attention as alternatives to phosphorescent materials containing heavy metallic elements. Melem, a small molecule with a heptazine backbone composed only of nitrogen, carbon, and hydrogen, is known to emit light in the near-ultraviolet region and exhibit high photoluminescence (PL) quantum yield and delayed fluorescence. However, the mechanism underlying the high PL quantum yield remains unclear. This study aimed to elucidate the mechanism of the high PL quantum yield of melem by examining its optical properties in detail. When the amount of dissolved oxygen in the melem solution was increased by bubbling oxygen through it, the PL quantum yield and emission lifetime decreased significantly, indicating that the triplet state was involved in the light-emission mechanism. Furthermore, the temperature dependence of the PL intensity of melem was investigated; the PL intensity decreased with decreasing temperature, indicating that it increases thermally. The experimental results show that melem is a TADF material that produces an extremely high PL quantum yield by upconversion from the triplet to the singlet excited state.

Elucidation of the speciation history of three sister species of crown-of-thorns starfish (Acanthaster spp.) based on genomic analysis

The crown-of-thorns starfish (COTS) is a coral predator that is widely distributed in Indo-Pacific Oceans. A previous phylogenetic study using partial mitochondrial sequences suggested that COTS had diverged into four distinct species, but a nuclear genome-based analysis to confirm this was not conducted. To address this, COTS species nuclear genome sequences were analysed here, sequencing Northern Indian Ocean (NIO) and Red Sea (RS) species genomes for the first time, followed by a comparative analysis with the Pacific Ocean (PO) species. Phylogenetic analysis and ADMIXTURE analysis revealed clear divergences between the three COTS species. Furthermore, within the PO species, the phylogenetic position of the Hawaiian sample was further away from the other Pacific-derived samples than expected based on the mitochondrial data, suggesting that it may be a PO subspecies. The pairwise sequentially Markovian coalescent model showed that the trajectories of the population size diverged by region during the Mid-Pleistocene transition when the sea-level was dramatically decreased, strongly suggesting that the three COTS species experienced allopatric speciation. Analysis of the orthologues indicated that there were remarkable genes with species-specific positive selection in the genomes of the PO and RS species, which suggested that there may be local adaptations in the COTS species.

Hydrogen bond-induced abrupt spin crossover behaviour in 1-D cobalt(II) complexes - the key role of solvate water molecules

The magnetic properties and structural aspects of the 1-D cobalt(ii) complexes, [Co(pyterpy)Cl2]·2H2O (1·2H2O; pyterpy = 4'-(4'''-pyridyl)-2,2':6',2''-terpyridine) and [Co(pyethyterpy)Cl2]·2H2O (2·2H2O; pyethyterpy = 4'-((4'''-pyridyl)ethynyl)-2,2':6',2''-terpyridine) are reported. In each complex the central cobalt(ii) ion displays an octahedral coordination environment composed of three nitrogen donors from the terpyridine moiety, a nitrogen donor from a pyridyl group and two chloride ligands which occupy the axial sites. 1·2H2O exhibits abrupt spin-crossover (SCO) behaviour (T1/2↓ = 218 K; T1/2↑ = 227 K) along with a thermal hysteresis loop, while 2·2H2O and the dehydrated species 1 and 2 exhibit high-spin (HS) states at 2-300 K as well as field-induced single-molecule magnet (SMM) behaviour attributed to the presence of magnetic anisotropic HS cobalt(ii) species (S = 3/2). 1·2H2O exhibited reversible desorption/resorption of its two water molecules, revealing reversible switching between SCO and SMM behaviour triggered by the dehydration/rehydration processes. Single crystal X-ray structural analyses revealed that 1·2H2O crystalizes in the orthorhombic space group Pcca while 2 and 2·2H2O crystallize in the monoclinic space group P2/n. Each of the 1-D chains formed by 1·2H2O in the solid state are bridged by hydrogen bonds between water molecules and chloride groups to form a 2-D layered structure. The water molecules bridging 1-D chains in 1·2H2O interact with the chloride ligands occupying the axial positions, complementing the effect of Jahn-Teller distortion and contributing to the abrupt SCO behaviour and associated stabilization of the LS state.

Gas sorption of nano-porous supramolecules formed by multi-hydrogen bonded coordination capsules

[{Re^I(CO)₃(Hbim)}₃(tpta)]₂ (1, Hbim^- = 2,2'-biimidazolate monoanion, tpta = 2,4,6-tripyridyl-1,3,5-triazine) was prepared as a nano-space supramolecule by using a new group of H-bonded coordination capsules. The hamburger bun-shaped half unit [{Re^I(CO)₃(Hbim)}₃(tpta)] contains six intermolecular H-bonds of Hbim^- ligands with complementary dual NHN types, and three [Re^I(CO)₃(Hbim)] are coordinated by bridging tridentate tpta. Interestingly, mechanical grinding easily would convert single crystals of 1 to an amorphous state with minor crystallinity while maintaining the nano-space pores. The ground sample can reversibly uptake and release small molecules such as CO₂ and (CH₂Cl)₂.

Solvent vapor-induced polarity and ferroelectricity switching

Vapor-induced crystal to crystal transformation between non-polar [Fe(sap)(acac)(sol)] (H₂sap = 2-salicylideneaminophenol, acac = acethylacetate, sol = MeOH, pyridine) and polar [Fe(sap)(acac)(DMSO)] was demonstrated. It provides an example of switchable ferroelectric behaviour attributted to the structural phase transition triggered by solvent vapour.

Luminescent ionic liquid formed from a melted rhenium(v) cluster

Recently, non-crystalline coordination materials have been shown to represent a versatile class of functional materials. However, such materials incorporating metal complex clusters have remained largely unexplored. Herein, we demonstrate that a luminescent tetranuclear ReV cluster melts at 489 K, with the cluster structure being maintained in the corresponding supercooled ionic liquid phase.

DNA methylation of GJA1, BMP2 and BMP4 in a human cementoblast cell line induced by lipopolysaccharide

AIM

To examine DNA methylation of GJA1, BMP2 and BMP4 in human cementoblasts (HCEM) induced by lipopolysaccharide (LPS).

METHODOLOGY

HCEM were cultured in osteoinduction medium. After 24 h, Escherichia coli LPS (1 μg/mL) was added to the medium, which was changed every 2-3 days. Untreated samples were used as controls. Messenger RNA was extracted after 4 weeks, and quantitative real-time polymerase chain reaction (qRT-PCR) for GJA1, BMP2, BMP4 and DNMT1 was performed. Genomic DNA was extracted after 4 weeks, and quantitative methylation-specific polymerase chain reaction was carried out for GJA1, BMP2 and BMP4. To detect mineralization, alizarin red and alkaline phosphatase staining were performed. The cells were also treated with the DNA methyltransferase inhibitor 5-Aza-2'-deoxycytidine (5Aza) and examined. The significance of differences amongst groups was assessed using a two-way analysis of variance (ANOVA) followed by Bonferroni's multiple comparison test with P < 0.05 being significant.

RESULTS

Decreased expression of mRNA was seen in GJA1, BMP2 and BMP4 after 4 weeks (P < 0.05). DNA hypermethylation was detected in GJA1, BMP2 and BMP4 (P < 0.05). Alizarin red staining and alkaline phosphatase staining revealed decreased mineralization levels in HCEM stimulated with LPS. 5Aza abolished the effects of DNA methylation in HCEM stimulated with LPS.

CONCLUSIONS

These results suggest that long-term LPS stimulation induces DNA methylation of GJA1, BMP2 and BMP4 in HCEM.

Slow Magnetic Relaxation Triggered by a Structural Phase Transition in Long-Chain-Alkylated Cobalt(II) Single-Ion Magnets

The behavior of single-ion magnets (SIMs) that reflects large distortions of their coordination environments caused by the packing of long alkyl chains for two Co(II) complexes of the type [Co(C _n-terpy)₂](BF₄)₂ (C _n-terpy = 4'-alkoxy-2,2':6',2″-terpyridine; n = 10 (1), 16 (2)) is reported. 1·2MeOH, which features a highly distorted octahedral high-spin Co(II) center, exhibits field-induced slow magnetic relaxation under an applied dc field of 1000 Oe. Further detailed analysis of the relaxation process indicated the prevalence of the Raman process at low temperature. Surprisingly, 2 shows a reverse spin transition (rST) and also exhibits remarkable field-induced SIM behavior, revealing the presence of magnetic anisotropy for this high-spin Co(II) species that is triggered by a structural phase transition. We present here the first examples of the coexistence of field-induced slow magnetic relaxation and rST associated with structural phase transitions involving long-alkyl-chain conformational changes from gauche to anti. These results indicate the prospect of inducing SIM properties in other distorted high-spin Co(II) species bearing long alkyl chains.

Phosphorescence at Low Temperature by External Heavy-Atom Effect in Zinc(II) Clusters

Luminescent Zn^II clusters [Zn₄ L₄ (μ₃ -OMe)₂ X₂ ] (X=SCN (1), Cl (2), Br (3)) and [Zn₇ L₆ (μ₃ -OMe)₂ (μ₃ -OH)₄ ]Y₂ (Y=I^- (4), ClO₄ ^- (5)), HL=methyl-3-methoxysalicylate, exhibiting blue fluorescence at room temperature (λ_max =416≈429 nm, Φ_em =0.09-0.36) have been synthesised and investigated in detail. In one case the external heavy-atom effect (EHE) arising the presence of iodide counter anions yielded phosphorescence with a long emission lifetime (λ_max =520 nm, τ=95.3 ms) at 77 K. Single-crystal X-ray structural analysis and time-dependent density-functional theory (TD-DFT) calculations revealed that their emission origin was attributed to the fluorescence from the singlet ligand-centred (¹ LC) excited state, and the phosphorescence observed in 4 was caused by the EHE of counter anions having strong CH-I interactions.

Weak ferromagnetism derived from spin canting in an amido-bridged homochiral Mn(iii) 1-D coordination polymer

An amido-bridged homochiral one-dimensional (1D) Mn(iii) coordination polymer behaves as a weak ferromagnet arising from spin canting with a coercive field of 3.0 kOe.

Creating capsules with cubanes

A sextuply linked capsule incorporating two Ni(ii) cubane units is formed when Ni(ii) salts are reacted with N-aminoalkyl salicylamidato ligands in a 4 : 3 ratio in methanol. With a short (propyl) alkyl substituent, additional chloride counter ions are included in the cavity by occupation of one apex of each of the linked cubanes, while with a longer (pentyl) substituent, perchlorate and tetrafluoroborate anions are included, probably by H-bonding involving hydroxyl groups on the inner apices of the cubanes, indicating that the cavity can be regarded as suited to binding of hydrophilic units despite the lipophilic character of its links. The dicubane capsules show ferromagnetic behaviour typical of Ni(ii) cubanes in general, with coupling constants dependent upon the nature of the salt-derived counter anions.

A New Treatment for Dialysis-Related Amyloidosis with β 2-Microglobulin Adsorbent Column

Dialysis-related amyloidosis (DRA) is characterized by the presence of β 2-microglobulin (β 2-m) in the plasma. In order to eliminate β 2-m from the circulating blood, the β 2-m selective adsorbent for direct hemoperfusion (DHP) was developed. A DHP column (BM-01), containing 350 ml of the adsorbent, was subjected to clinical trials. The column was connected with a PAN (AN69) membrane dialyzer in series and used 3 times a week for 1 week (11 patients), 4 weeks (5 patients), 6 months (1 patient) and 12 months (2 patients). The percent reduction (%) of β 2-m was for 16 patients (for 1 or 4 weeks), more than 65, and for 3 patients (for more than 6 months), 76.5 ± 4.9, 73.5 ± 5.7, 72.2 ± 6.2. At the end of each session, β 2-m plasma levels were found to be below 10 mg/L, with 3.4 mg/L being the lowest. The total amounts of β 2-m removed were 172.5 ± 22.3, 257.0 ± 75.6, 157.6 ± 32.2 and 429.8 mg/session at max. Two out of these three patients had a favorable effect on joint symptoms and ocular fundus. It can be concluded that this selective adsorption therapy may delay the progression of DRA, and is worth considering for wide application.

Intermolecular Interaction Tuning of Spin-Crossover Iron(III) Complexes with Aromatic Counteranions

Iron(III) spin-crossover (SCO) complexes [Fe(qsal)₂]BS·MeOH·H₂O (1), [Fe(qsal)₂](NS)·MeOH (2), [Fe(qnal)₂](NS) (3), and [Fe(qnal)₂]PS·MeOH·CH₂Cl₂ (4) (Hqsal, N-(8-quinolinyl)salicylaldimine; Hqnal, N-(8-quinolinyl)-2-hydroxy-1-naphthaldimine; BS, benzenesulfonate; NS, 1-naphthalenesulfonate; PS, 1-pyrenesulfonate) have been synthesized and characterized by X-ray structure determinations and temperature-dependent magnetic susceptibility measurements. The aromatic counteranions BS, NS, and PS can be used for the tuning of intermolecular coupling through a variety of weak interactions. All of the complexes show temperature-dependent SCO behavior. but the light-induced excited spin-state trapping (LIESST) effect was observed only for 1, 3, and 4 when the samples were illuminated (λ 808 nm) for 1 h at 5 K. In particular, 59% of the LS form of 1 was converted to the metastable HS state by illumination, equal to the highest degree of conversion yet known for LIESST in [Fe(qsal)₂]⁺ derivatives. The lack of a LIESST effect for 2 may be due to the relatively limited degree of interaction between the cations and anions in the lattice, reflected in a much longer minimum Fe···Fe separation in this complex in comparison to the others.

Wheel-type heterometallic ferromagnetic clusters: [Ni7−xMx(HL)6(μ3-OMe)4(μ3-OH)2]Cl2 (M = Zn, Co, Mn; x = 1, 3)

Wheel-type heptanuclear heterometallic clusters display metal ion dependent ferromagnetic properties and express single molecule magnet behavior based on the magnetic anisotropy.

Response of porcine epithelial rests of Malassez to stimulation by interleukin-6

AIM

To investigate the proliferation and migration of epithelial cell rests of Malassez (ERM) after stimulation with IL-6.

METHODOLOGY

Porcine-derived ERM were seeded on Dulbecco's modified Eagle's Medium, and IL-6 (100 pg mL^-1 ) was incorporated into the culture medium. The WST-1 assay was performed to evaluate cell proliferation, and absorption was measured at 450 nm. A wound-healing assay and immunofluorescence assay for integrin α₃ were conducted to investigate migration. The Kruskal-Wallis test and the Mann-Whitney U-test with Bonferroni correction were used to analyse data of WST-1 and wound-healing assays.

RESULTS

Cell proliferation following the stimulation by IL-6 increased over time, with a significant increase being observed at 6 h (P < 0.05), but not in a concentration-dependent manner. Cell proliferation was significantly greater in IL-6-treated ERM than in nontreated ERM (P < 0.05). The results of the wound-healing assay revealed earlier closure in IL-6-treated ERM (P < 0.05). In the immunofluorescence assay, integrin α₃ was detected at the edge of cell processes adjacent to the wound area. A neutralized antibody abrogated the effects of the IL-6 stimulation in cell proliferation and migration.

CONCLUSION

IL-6 promoted the proliferation and migration of porcine ERM in vitro.

Crystal structure of [2-({2-[(2-azanidylbenzylidene)amino]benzylidene}amino)-4-chlorophenolato]nickel(II)

The metal atom of the title compound is four coordinated. The asymmetrically appended Cl atom and a widely spread π-conjugated system of the complex mol­ecule construct the supra­molecular structures of a hydrogen-bonded chain and a π–π inter­acted column.

The title complex, [Ni(C₂₀H₁₄ClN₃O)], with an asymmetrically chloride-appended Schiff base ligand has been synthesized and structurally characterized at 100 K. In the compound, the central nickel(II) ion has a square-planar coordination geometry with N₃O donors of the π-conjugated tetra­dentate Schiff base ligand. In the crystal, the complexes are connected into an inversion dimer via an Ni⋯Ni inter­action [3.1753 (5) Å] and a pair of π–π inter­actions [centroid–centroid distance = 3.8416 (16) Å]. The dimers are linked via a C—H⋯Cl hydrogen bond, forming a chain along the c-axis direction. The dimer chains inter­act with each other through π–π inter­actions [centroid–centroid distance = 3.8736 (16) Å], forming a layer expanding parallel to the ac plane.

Syntheses, structures and magnetic properties of tetranuclear cubane-type and heptanuclear wheel-type nickel(ii) complexes with 3-methoxysalicylic acid derivatives

Three mono- and multi-nuclear Ni(ii) compounds were synthesised and investigated.

Actin stabilization induces apoptosis in cultured porcine epithelial cell rests of Malassez

AIM

To test whether actin stabilization by jasplakinolide induces inhibition of cell viability and apoptosis in epithelial cell rests of Malassez (ERM).

METHODOLOGY

ERM derived from porcine were spread in a 96-well dish (5 × 10(4) /well) using Dulbecco's modified Eagle's medium. The actin-specific stabilization reagent, jasplakinolide, was incorporated into the culture medium and incubated for 24 h. To evaluate cell viability, the WST-1 assay was carried out and absorption (450 nm) was measured. To detect apoptotic cells, monoclonal antibody to single-strand DNA (ssDNA) was used and absorption (405 nm) was measured. Actin stabilization and apoptosis induced by jasplakinolide were morphologically investigated by staining with Alexa Fluor 568 phalloidin and observed under a fluorescent microscope. As a negative control, DMSO was used instead of jasplakinolide. Differences between the jasplakinolide-treated group and the control group were analysed statistically using the Student's t-test.

RESULTS

Cell viability decreased in a concentration-dependent manner, and cell viability in the jasplakinolide-treated ERM was lower than that in nontreated ERM (n = 16, P < 0.01). Apoptotic cells in the jasplakinolide-treated ERM were more frequently detected compared to that in nontreated ERM (n = 16, P < 0.01). Morphologically, shrinkage, irregular forms and fragmentation of nuclei suggesting apoptotic bodies were observed in jasplakinolide-treated ERM, whilst actin filaments were extended in non-treated ERM.

CONCLUSION

Actin stabilization by jasplakinolide inhibited cell viability and induced apoptosis in epithelial cell rests of Malassez.

Cell type-dependent effects of corticosteroid on periostin production by primary human tissue cells

Overproduction of periostin, an IL-13-inducible matricellular protein, despite corticosteroid treatment is thought to be involved in the chronicity of allergic inflammation seen in corticosteroid-refractory tissue fibrosis. Therefore, we hypothesized that some tissue cells must produce periostin in a corticosteroid-insensitive manner. Here, we show that IL-4 and IL-13 each induced comparable levels of periostin production by primary normal human fibroblasts and microvascular endothelial cells derived from lung and skin. Dexamethasone, a corticosteroid, completely inhibited IL-4/13-induced, but did not affect TGF-β-induced, periostin production by fibroblasts. In contrast, dexamethasone synergistically enhanced IL-4/13-induced periostin production by microvascular endothelial cells. TGF-β did not induce periostin production by microvascular endothelial cells. Our novel findings suggest that IL-4/13-induced microvascular endothelium-derived and/or TGF-β-induced fibroblast-derived periostin might play a pivotal role in corticosteroid-refractory tissue fibrosis, leading to chronic allergic inflammation in the lung and/or skin.

Ozone microbubble treatment at various water temperatures for the removal of residual pesticides with negligible effects on the physical properties of lettuce and cherry tomatoes

In this study, the effects of ozone microbubbles (OMCB) treatment at various water temperatures on the removal of residual fenitrothion (FT) pesticides and on the physical properties of lettuce and cherry tomatoes was examined. The residual FT percentage in lettuce and cherry tomatoes was shown decreased by using higher water temperatures, particularly at 30 °C, resulting in a decrease within the range of 32% to 52%, after the 20-min treatment. In addition, bubbling OMCB treatment did not alter the color and pulling strength of lettuce and cherry tomatoes. These results indicate that bubbling OMCB treatment at 30 °C is a highly effective method for the removal of FT residues in lettuce and cherry tomatoes, with relatively little effect on crop quality.

PRACTICAL APPLICATION

The bubbling OMCB has a potential of reducing the FT reduces on vegetables with no adverse effect on the sensory quality of vegetables.

Effects of olmesartan on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy: a multicentre, randomised, placebo-controlled study

AIMS/HYPOTHESIS

The renal and cardiovascular protective effects of angiotensin receptor blocker (ARB) remain controversial in type 2 diabetic patients treated with a contemporary regimen including an angiotensin converting enzyme inhibitor (ACEI).

METHODS

We examined the effects of olmesartan, an ARB, on primary composite outcome of doubling of serum creatinine, endstage renal disease and death in type 2 diabetic patients with overt nephropathy. Secondary outcome included composite cardiovascular outcomes, changes in renal function and proteinuria. Randomisation and allocation to trial group were carried out by a central computer system. Participants, caregivers, the people carrying out examinations and people assessing the outcomes were blinded to group assignment.

RESULTS

Five hundred and seventy-seven (377 Japanese, 200 Chinese) patients treated with antihypertensive therapy (73.5% [n = 424] received concomitant ACEI), were given either once-daily olmesartan (10-40 mg) (n = 288) or placebo (n = 289) over 3.2 ± 0.6 years (mean±SD). In the olmesartan group, 116 developed the primary outcome (41.1%) compared with 129 (45.4%) in the placebo group (HR 0.97, 95% CI 0.75, 1.24; p = 0.791). Olmesartan significantly decreased blood pressure, proteinuria and rate of change of reciprocal serum creatinine. Cardiovascular death was higher in the olmesartan group than the placebo group (ten vs three cases), whereas major adverse cardiovascular events (cardiovascular death plus non-fatal stroke and myocardial infarction) and all-cause death were similar between the two groups (major adverse cardiovascular events 18 vs 21 cases, all-cause deaths; 19 vs 20 cases). Hyperkalaemia was more frequent in the olmesartan group than the placebo group (9.2% vs 5.3%).

CONCLUSIONS/INTERPRETATION

Olmesartan was well tolerated but did not improve renal outcome on top of ACEI.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00141453.