RESUMEN
La denervación de las arterias renales ha sido una alternativa para el tratamiento de la hipertensión arterial resistente. Los estudios Symplicity HTN 1 y 2 mostraron en grupos pequeños y no controlados disminuciones de la presión sistólica hasta de 30 mm Hg. Este entusiasmo ha sido opacado por el estudio Symplicity HTN 3, ensayo clínico aleatorizado y controlado con un procedimiento placebo. Sorprendentemente, los resultados sugirieron que la denervación renal tuvo un efecto similar al del placebo, aunque en el análisis de subgrupos preespecificados los pacientes que no eran de raza negra, los menores de 65 años y los que tenían función renal normal tuvieron una reducción de la presión arterial sistólica estadísticamente significativa. Esta es una evaluación crítica de los resultados del Symplicity HTN 3 y propone posibles explicaciones para estos. Además, declara la postura de nuestro grupo y las acciones futuras.
Renal artery denervation has shown to be an effective treatment for resistant hypertension. Symplicity HTN 1 and 2 trials showed in small and uncontrolled groups, significant systolic blood pressure reductions down to 30 mm Hg. Symplicity HTN-3, a double blind, randomized, placebo controlled clinical trial shaded this initial enthusiasm. Surprisingly, their results showed that renal denervation has a similar effect to placebo. Pre-specified subgroup analysis showed that non-black race individuals, younger than 65 years and with normal renal function, had a statistically significant systolic blood pressure decrease. This manuscript critically appraises the Symplicity HTN-3 trial, proposing possible explanations for the results. Also declares our group position and future actions regarding renal denervation.
Asunto(s)
Humanos , Desnervación , Hipertensión/cirugía , Riñón/inervación , Riñón/cirugía , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Renal artery denervation has shown to be an effective treatment for resistant hypertension. Symplicity HTN 1 and 2 trials showed in small and uncontrolled groups, significant systolic blood pressure reductions down to 30 mm Hg. Symplicity HTN-3, a double blind, randomized, placebo controlled clinical trial shaded this initial enthusiasm. Surprisingly, their results showed that renal denervation has a similar effect to placebo. Pre-specified subgroup analysis showed that non-black race individuals, younger than 65 years and with normal renal function, had a statistically significant systolic blood pressure decrease. This manuscript critically appraises the Symplicity HTN-3 trial, proposing possible explanations for the results. Also declares our group position and future actions regarding renal denervation.
Asunto(s)
Desnervación , Hipertensión/cirugía , Riñón/inervación , Riñón/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , HumanosRESUMEN
BACKGROUND: 2-octylcyanoacrylate (2OCA) is a liquid monomer that polymerizes on contact with a surface by an exothermic reaction creating a strong and flexible film. The addition of sodium bicarbonate accelerates the polymerization. The aim was to use the combination of 2OCA and sodium bicarbonate in the treatment of zygomatic arch fractures in an animal model and to evaluate the biocompatibility and bone healing. METHODS: twenty animals were subjected to bilateral zygomatic arch fracture under surgical sedation, and using 2OCA fixation and sodium bicarbonate for the experimental side and without fixation for the control side. Observation was over a period from two to four weeks, assessing biocompatibility, stability and consolidation. RESULTS: at the end of two and four weeks the twenty animals showed the presence of osseous callus and continuity of marrow channel measured by macroscopic and radiography examinations. CONCLUSIONS: the use of 2-octylcyanoacrylate and sodium bicarbonate led to the stabilization and reduction of bilateral zygomatic arch fractures in an animal model without adverse reactions.
