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Concept: Blood pressure


Meditation is associated with positive health behaviors and improved cognitive control. One mechanism for the relationship between meditation and cognitive control is changes in activity of the anterior cingulate cortex-mediated neural pathways. The error-related negativity (ERN) and error positivity (Pe) components of the scalp-recorded event-related potential (ERP) represent cingulate-mediated functions of performance monitoring that may be modulated by mindfulness meditation. We utilized a flanker task, an experimental design, and a brief mindfulness intervention in a sample of 55 healthy non-meditators (n = 28 randomly assigned to the mindfulness group and n = 27 randomly assigned to the control group) to examine autonomic nervous system functions as measured by blood pressure and indices of cognitive control as measured by response times, error rates, post-error slowing, and the ERN and Pe components of the ERP. Systolic blood pressure significantly differentiated groups following the mindfulness intervention and following the flanker task. There were non-significant differences between the mindfulness and control groups for response times, post-error slowing, and error rates on the flanker task. Amplitude and latency of the ERN did not differ between groups; however, amplitude of the Pe was significantly smaller in individuals in the mindfulness group than in the control group. Findings suggest that a brief mindfulness intervention is associated with reduced autonomic arousal and decreased amplitude of the Pe, an ERP associated with error awareness, attention, and motivational salience, but does not alter amplitude of the ERN or behavioral performance. Implications for brief mindfulness interventions and state vs. trait affect theories of the ERN are discussed. Future research examining graded levels of mindfulness and tracking error awareness will clarify relationship between mindfulness and performance monitoring.

Concepts: Controlling for a variable, Scientific control, Nervous system, Scientific method, Psychology, Brain, Blood pressure, Autonomic nervous system


Recent studies have described that the Notch signaling pathway is activated in a wide range of renal diseases. Angiotensin II (AngII) plays a key role in the progression of kidney diseases. AngII contributes to renal fibrosis by upregulation of profibrotic factors, induction of epithelial mesenchymal transition and accumulation of extracellular matrix proteins. In cultured human tubular epithelial cells the Notch activation by transforming growth factor-β1 (TGF-β1) has been involved in epithelial mesenchymal transition. AngII mimics many profibrotic actions of TGF-β1. For these reasons, our aim was to investigate whether AngII could regulate the Notch/Jagged system in the kidney, and its potential role in AngII-induced responses. In cultured human tubular epithelial cells, TGF-β1, but not AngII, increased the Notch pathway-related gene expression, Jagged-1 synthesis, and caused nuclear translocation of the activated Notch. In podocytes and renal fibroblasts, AngII did not modulate the Notch pathway. In tubular epithelial cells, pharmacological Notch inhibition did not modify AngII-induced changes in epithelial mesenchymal markers, profibrotic factors and extracellular matrix proteins. Systemic infusion of AngII into rats for 2 weeks caused tubulointerstitial fibrosis, but did not upregulate renal expression of activated Notch-1 or Jagged-1, as observed in spontaneously hypertensive rats. Moreover, the Notch/Jagged system was not modulated by AngII type I receptor blockade in the model of unilateral ureteral obstruction in mice. These data clearly indicate that AngII does not regulate the Notch/Jagged signaling system in the kidney, in vivo and in vitro. Our findings showing that the Notch pathway is not involved in AngII-induced fibrosis could provide important information to understand the complex role of Notch system in the regulation of renal regeneration vs damage progression.

Concepts: Chronic kidney disease, Kidney, Extracellular matrix, Blood pressure, Ureter, Renin-angiotensin system, Renal pelvis, Endocrine system


A 46-year old male patient was admitted with a history of an extremely painful right upper arm, associated with unilateral clubbing. Duplex scanning and magnetic resonance imaging were suggestive of a pseudo-aneurysm of the brachial artery. Digital angiography showed an irregular brachial artery, associated with a small pseudo-aneurysm. The brachial artery was partially resected and reconstructed with a venous interposition graft. Pathological examination provided the final diagnosis of fibromuscular dysplasia. Although more encountered in women, this case report describes the occurrence of fibromuscular dysplasia in an unusual location in a male patient with a long-term follow-up.

Concepts: X-ray, Blood pressure, Medical imaging, Nuclear magnetic resonance, Magnetic resonance imaging, Humerus, Radiology, Brachial plexus


Chronic treatment with angiotensin receptor blockers is largely accepted for protecting cerebral circulation during hypertension, but beneficial effects of short-term treatments are questionable, as highlighted by the recent SCAST trial. We compared the impact of 10 days treatment with candesartan (as SCAST) versus telmisartan (previously described to reverse arteriolar remodeling, chronic treatment) on pial arterioles of spontaneously hypertensive rats (SHR). We explored whether PPAR-gamma agonist activity or AT(1) receptor blockade are involved in their differential effects. In the first study, 4-month-old male SHR were treated with telmisartan (TELMI, 2 mg/kg per day) or candesartan cilexetil (CANDE, 10 mg/kg per day) and compared to vehicle treated SHR and normotensive WKY. In a second study, SHR were treated with CANDE, pioglitazone (a PPAR-gamma agonist, PIO 2.5 mg/kg per day) or CANDE+PIO, compared to TELMI. Internal diameter of pial arterioles (ID, cranial window) was measured at baseline, during hemorrhage-induced hypotension, or following suffusion of Ang II (10(-6) mol/L) or EDTA inactivation of smooth muscle cells (passive ID). PPAR-gamma and eNOS (target gene of PPAR-gamma) mRNA were evaluated in brain microvessels. For similar antihypertensive effects, TELMI (+44% versus SHR), but not CANDE, increased baseline ID. During hemorrhage, ID in TELMI group was similar to WKY, while ID in SHR and CANDE remained lower. In the second study, TELMI (+36%, versus SHR) and CANDE+PIO (+43%) increased baseline ID, but not CANDE or PIO alone. TELMI (-66%) and CANDE+PIO (-69%), but neither CANDE nor PIO alone, decreased Ang II-induced vasoconstriction. CANDE+PIO, but not CANDE, increased passive ID. In both studies, PPAR-gamma and eNOS expressions were higher in TELMI than CANDE. Short-term treatment with TELMI, but not with CANDE, reverses narrowing of pial arteriolar ID in SHR. This may involve PPAR-gamma related mechanisms, since CANDE+PIO treatment induced similar effects, and a better blockade of AT(1) receptors.

Concepts: Hypertension, Blood pressure, Smooth muscle, Angiotensin, Angiotensin II receptor antagonist, Angiotensin receptor, Candesartan, Angiotensin II receptor antagonists


BACKGROUND: Hypertension is a risk factor for cardiovascular disease, and the prevalence of hypertension tends to increase with age. Current treatments for hypertension have adverse side effects and poor adherence. The purpose of this study is to evaluate the effects of moxibustion on blood pressure in individuals with pre- or stage I hypertension.Methods/designForty-five subjects with pre- or stage I hypertension will be randomized into three groups: treatment group A (2 times/week), treatment group B (3 times/week), and the control group (non-treated group). The inclusion criteria will be as follows: (1) aged between 19 and 65 years; (2) prehypertension or stage I hypertension (JNC 7, Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure); (3) the participants are volunteers and written consent obtained.The participants in the treatment group A will undergo indirect moxibustion 2 times per week for 4 weeks, and the participants in the treatment group B will undergo indirect moxibustion 3 times per week for 4 weeks. The participants in the control group (non-treated group) will maintain their current lifestyle, including diet and exercise. The use of antihypertensive medication is not permitted. The primary endpoint will be a change in patient blood pressure. The secondary endpoints will be the body mass index, lipid profile, EuroQol and Heart Rate Variability. The data will be analyzed with the Student’s t-test and analysis of variance (ANOVA) (p < 0.05). DISCUSSION: The results of this study will help to establish the optimal approach for the care of adults with pre- or stage I hypertension.Trial registrationClinical Research Information Service KCT0000469.

Concepts: Myocardial infarction, Hypertension, Obesity, Randomized controlled trial, Blood pressure, Normal distribution, Analysis of variance, F-test


BACKGROUND: This study sought to investigate a possible correlation between the intestinal microbiota, Bacteroidetes and Firmicutes, and obesity in Kazakh school children, aged 7–13 (n = 175). RESULTS: Obese subjects had significantly greater systolic blood pressure, waist and hip circumference, as well as HOMA-IR as compared to normal and overweight participants. In addition, Bacteroides copy number and Bact/Firm ratios were significantly lower in the obese group as compared to the normal and overweight groups (P < 0.0167). This difference is only significant in girls, but not in boys when stratified by gender. Furthermore, a negative correlation between BMI and Bacteroidetes copy number (r = -0.18, P = 0.017) as well as Bact/Firm (r = -0.22, P = 0.003) was observed. CONCLUSION: An association between reduced gut Bacteroidetes and Bact/Firm ratio with obesity in female Kazakh children was identified. Further studies are necessary to elucidate the mechanism behind these changes as well as the value of determining their presence for predicting obesity.

Concepts: Bacteria, Gut flora, Nutrition, Myocardial infarction, Hypertension, Obesity, Blood pressure, Waist-hip ratio


BACKGROUND: Hypertensive disorders in pregnancy are associated with systemic endothelial dysfunction leading to impaired physiological vasodilation. Recent evidence has shown central aortic pressures obtained through pulse wave analysis, at less than 14 weeks of gestation, to be predictive of pre-eclampsia. In light of this, we aimed to evaluate the role of central aortic stiffness in the prediction and discrimination of hypertensive disorders in pregnancy. METHODS: A cohort study of women with viable, singleton pregnancies at less than 14 weeks of amenorrhoea, and without multiple pregnancies, autoimmune or renal disease, diagnosed with aneuploidy or fetal anomaly will be recruited from a single maternity hospital and followed up till delivery and puerperium. A targeted sample size of 1000 eligible pregnant women will be enrolled into the study from antenatal clinics. Main exposure under study is central aortic pulse pressure using radial pulse wave recording, and the outcomes under follow-up are gestational hypertension and pre-eclampsia. Other measures include lifestyle factors such as smoking, physical exercise, psychometric evaluations, vasoactive factors, uterine artery pulsatility index, height and weight measurements. These measures will be repeated over 4 antenatal visits at 11-14, 18-22, 28-32 and above 34 weeks of gestation. Double data entry will be performed on Microsoft Access, and analysis of data will include the use of random effect models and receiver operating characteristic curves on Stata 11.2. DISCUSSION: The proposed study design will enable a longitudinal evaluation of the central aortic pressure changes as a marker for vascular compliance during pregnancy. As measures are repeated over time, the timing and severity of changes are detectable, and findings may yield important information on how aberrant vascular responses occur and its role in the early detection and prediction of hypertensive disorders.

Concepts: Pregnancy, Childbirth, Hypertension, Embryo, Fetus, Uterus, Blood pressure, Obstetrics


Angiotensin-converting enzyme (ACE) is a zinc-dependent peptidase responsible for converting angiotensin I into the vasoconstrictor angiotensin II. However, ACE is a relatively nonspecific peptidase that is capable of cleaving a wide range of substrates. Because of this, ACE and its peptide substrates and products affect many physiologic processes, including blood pressure control, hematopoiesis, reproduction, renal development, renal function, and the immune response. The defining feature of ACE is that it is composed of two homologous and independently catalytic domains, the result of an ancient gene duplication, and ACE-like genes are widely distributed in nature. The two ACE catalytic domains contribute to the wide substrate diversity of ACE and, by extension, the physiologic impact of the enzyme. Several studies suggest that the two catalytic domains have different biologic functions. Recently, the X-ray crystal structure of ACE has elucidated some of the structural differences between the two ACE domains. This is important now that ACE domain-specific inhibitors have been synthesized and characterized. Once widely available, these reagents will undoubtedly be powerful tools for probing the physiologic actions of each ACE domain. In turn, this knowledge should allow clinicians to envision new therapies for diseases not currently treated with ACE inhibitors.

Concepts: DNA, Evolution, Enzyme, Physiology, Blood pressure, Angiotensin, Renin-angiotensin system, Angiotensin-converting enzyme


BACKGROUND: Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. CASE PRESENTATION: During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. CONCLUSION: As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

Concepts: Blood pressure, Muscle, Ulna, Forearm, Median nerve, Brachial artery, Muscles of the upper limb, Ulnar artery


BACKGROUND: This study was designed to assess the safety, tolerability, and efficacy of intravenous infusion of CA4P in patients with neovascular age-related macular degeneration (AMD). METHODS: Prospective, interventional, dose-escalation clinical trial. Eight patients with neovascular AMD refractory to at least 2 sessions of photodynamic therapy received CA4P at a dose of 27 or 36 mg/m2 as weekly intravenous infusion for 4 consecutive weeks. Safety was monitored by vital signs, ocular and physical examinations, electrocardiogram, routine laboratory tests, and collection of adverse events. Efficacy was assessed using retinal fluorescein angiography, optical coherence tomography, and best corrected visual acuity (BCVA). RESULTS: The most common adverse events were elevated blood pressure (46.7%), QTc prolongation (23.3%), elevated temperature (13.3%), and headache (10%), followed by nausea and eye injection (6.7%). There were no adverse events that were considered severe in intensity and none resulted in discontinuation of treatment. There was reduction of the excess foveal thickness by 24.15% at end of treatment period and by 43.75% at end of the two-month follow-up (p = 0.674 and 0.161, respectively). BCVA remained stable throughout the treatment and follow-up periods. CONCLUSIONS: The safety profile of intravenous CA4P was consistent with that reported in oncology trials of CA4P and with the class effects of vascular disruptive agents; however, the frequency of adverse events was different. There are evidences to suggest potential efficacy of CA4P in neovascular AMD. However, the level of systemic safety and efficacy indicates that systemic CA4P may not be suitable as an alternative monotherapy to current standard-of-care therapyTrial registration: NCT01570790.

Concepts: Clinical trial, Optics, Blood pressure, Retina, Macular degeneration, Photodynamic therapy, Combretastatin A-4, Combretastatin A-4 phosphate