Antihypertensive effect of a fixed-dose combination of losartan/hydrochlorothiazide in patients with uncontrolled hypertension: a multicenter study.

BACKGROUND: Achieving adequate blood pressure (BP) control often requires more than one antihypertensive agent. The purpose of this study was to determine whether a fixed-dose formulation of losartan (LOS) plus hydrochlorothiazide (HCTZ) (LOS/HCTZ) is effective in achieving a greater BP lowering in patients with uncontrolled hypertension. METHODS: The study was a prospective, multicenter, observational trial exploring the antihypertensive effect of a single tablet of LOS 50 mg/HCTZ 12.5 mg. A total of 228 patients whose BP had previously been treated with more than one antihypertensive agents without having achieved BP goal below 130/80 mmHg enrolled in the study. RESULTS: A significant decrease in systolic and diastolic BP was observed in both clinic and home measurement after switching from the previous treatment to LOS/HCTZ. There was a significant decrease in both B-type natriuretic peptide (BNP) and urinary albumin creatinine (Cr) excretion ratio (ACR), especially in patients with elevated values. In contrast, there was a significant increase in serum Cr concentration in conjunction with a decrease in estimated glomerular filtration rate (eGFR). Overall serum uric acid (UA) concentration increased, whereas in patients with hyperuricemia there was a significant reduction in this value. CONCLUSION: Switching to LOS/HCTZ provides a greater reduction in clinic and home BP in patients with uncontrolled hypertension. This combination therapy may lead to cardio-, reno protection and improve UA metabolism.

Radiation-induced gamma-H2AX in mammalian cells irradiated with a synchrotron X-ray microbeam.

In order to study the radiobiological effects from low dose radiation, a cell irradiation system using synchrotron X-ray microbeam has been developed, by which cells can be recognised individually and irradiated one by one with the desired dose of monochromatic X rays. The minimum beam sizes obtained are 2 microm with the focusing optics and 5 microm square with the non-focused beam, and the beam size can be changed easily with a high-precision slit in the case of a non-focused beam. Human fibroblast cells were individually irradiated with this system, and immunostained by gamma-H2AX antibody to visualise the DNA damage. Most of the fluorescent foci were observed in a localised area in cell nuclei, the size of which was almost the same as the beam size.

Note: On the wavelength dependence of the intensity calibration factor of extreme ultraviolet spectrometer determined with profile measurement of bremsstrahlung continuum.

The absolute calibration factor of extreme ultraviolet spectroscopic instrument which has recently been determined from absolute radiation profile measurement of bremsstrahlung continuum has been investigated by comparing the calculated diffraction efficiency of grating. An overall tendency of the wavelength dependence of the calibration factor from 40 Å to 500 Å can be reproduced by that of the grating efficiency, especially the agreement between the measured calibration factor and the calculated grating efficiency has been found to be fairly good for the wavelength range 200 Å-500 Å.

Radiosensitivity of mouse skin epithelial cell line established in serum-free culture: an alternative to animal use.

A cultured line of murine skin epithelial cells was established to investigate the potential use of cultured cells as an alternative to animal use in radiation research. C3Hf/Sed newborn mouse skin cells have been successfully cultured in serum- and Ca(2+)-free medium with no terminal differentiation to keratinized cells. Presently, more than 25 passages have passed with no loss of stem cell capability. The radiosensitivity and repair of sublethal and potentially lethal radiation damages were investigated in this epithelial cell line. The population cell doubling time was 25 +/- 2.9 hr at 37 degrees C. The clonal growth of epithelial cells after irradiation was performed in the serum-free medium in the presence of lethally irradiated skin fibroblasts. Single dose survival curves of exponentially growing epithelial cells were investigated from the seventh to the twenty-third passages, and no significant changes in radiosensitivity and doubling time were found. The confluent epithelial cells also showed an identical sensitivity to radiation. The alpha/beta ratios of survival curves fitted by the linear quadratic model were 6.1 +/- 1.0 and 5.9 +/- 1.3 Gy for cells in exponential and confluent phases, respectively. The survival curve of epithelial cells left in confluence for 8 hr after irradiation showed a smaller beta value than that of cells plated immediately after irradiation with a resultant alpha/beta ratio of 9.5 +/- 3.8 Gy. This alpha/beta ratio was identical to those found in many animal experiments, suggesting a potential use of this cell line as an alternative to animal use. The magnitude of repair of sublethal damage following 6 Gy was greater than that following 3.9 Gy. Survival curves were also obtained following twice-a-day irradiations with no sign of rapid repopulation. These results are discussed by comparing with published in vivo and in vitro data.

Thallium-201 stress scintigraphy in Takayasu arteritis.

Thirty-eight women with Takayasu arteritis were studied using thallium-201 stress myocardial scintigraphy to assess the prevalence and pathophysiology of the perfusion abnormality. Twenty (53%) had abnormal scintigraphic findings (group A). Abnormal scans were divided into 3 groups: permanent defects in 6, reversible defects in 7 and slow washout in 7. The remaining 18 patients had normal scintigrams (group N). Group A had a tendency to be older and to have a high prevalence of complicated significant aortic regurgitation. Interventricular thickness plus left ventricular posterior wall thickness (26 +/- 7 vs 17 +/- 2 mm, p less than 0.01) and left ventricular mass (267 +/- 121 vs 133 +/- 39 g, p less than 0.01) were all greater in group A on echocardiography. The mean value of the central aortic pressure in systole was 170 +/- 15 mm Hg in the 7 catheterized patients in group A. Coronary ostial stenoses were present in 2 group A patients who showed reversible defects on scintigrams. These data indicate that the abnormal perfusion detected by imaging in patients with Takayasu arteritis was responsible for a decrease in coronary reserve or myocardial damage, or both, due to long-standing systemic hypertension or aortic regurgitation. Coronary artery disease should be considered if a reversible defect is present.

Synchrotron system for monochromatic uv irradiation (greater than 140 nm) of biological material.

An irradiation system of monochromatic uv radiation down to the wavelength of 140 nm was constructed for biological irradiation experiments in the vacuum-uv range using synchrotron radiation (SR) from the electron storage ring. The system consists of premirror chamber, vacuum-uv monochromator, irradiation chamber, and vacuum systems. Along with the detailed description of all components of the system, the installation at the storage ring and the performance characteristics are presented.

Action spectra for inactivation of dry phage T1 after monochromatic (150-254 nm) synchrotron irradiation in the presence and absence of photoreactivation and dark repair.

Dry phage T1 was irradiated with monochromatic uv radiation (150-254 nm) in vacuo. The inactivation sensitivity was highest at 150 nm. On Escherichia coli Bs-1, the phage inactivation sensitivity was two and four times higher at 150 nm than at 254 and 230 nm, respectively. Action spectra for phage inactivation on both E. coli B and Bs-1 fit the absorption spectrum of phage DNA, except around 190 nm. The host-cell- reactivable fraction for vacuum-uv radiation (below 190 nm) was smaller than that with far-uv radiation. There was almost no photoreactivation at 150 nm, in contrast to a photoreactivation sector of about 0.3 at 254 nm.

Serum ketone response to glucagon as a marker of insulin dependency in diabetics.

The serum ketone response to glucagon was measured in 10 patients with IDDM and 37 with NIDDM. In both groups, serum 3-hydroxybutyrate increased significantly after intravenous injection of 1 mg glucagon. The difference between the serum level of 3-hydroxybutyrate at 30 min and basal level [delta 3-OHBA(30')] was 133 +/- 25 mumol/l in the patients with IDDM, 13 +/- 8 mumol/l in those with NIDDM treated by diet alone or with oral hypoglycemic agents and 23 +/- 13 mumol/l in those with NIDDM treated with insulin. The delta 3-OHBA(30') was significantly greater in IDDM patients than in both groups of NIDDM patients (P less than 0.001). The delta 3-OHBA(30') was greater than 87 mumol/l in eighty percent of IDDM patients, but smaller than 87 mumol/l in both groups of NIDDM patients. The delta 3-OHBA(30') was correlated with the difference between the plasma level of C-peptide at 6 min and basal level [delta CPR(6')] (r = -0.540, P less than 0.001). The delta 3-OHBA(30') was not correlated with fasting plasma levels of glucose, fructosamine or hemoglobin A1c. These observations show that measurement of the serum ketone response to glucagon is a useful marker of insulin dependency. In order to determine insulin dependency, the simultaneous measurement of concentrations of ketones and C-peptide is indicated during the glucagon stimulation test.

Relationship between the R-R interval variation and metabolic states of diabetes.

To investigate whether the metabolic state of diabetes affects the R-R interval variation, 82 diabetics were studied at intervals of about 1 month and of about 1 year. There was no significant relationship between the rate of change for FBG and that for R-R interval variation at both these intervals. However, in the cases that showed a change of HbA1 by more than 10% in a month, the rate of change for the R-R interval variation was 20 +/- 30% in the group with improved HbA1 and -9 +/- 17% in the group with aggravated HbA1, demonstrating a significant difference (P less than 0.05) between the 2 groups. There was a significant difference (P less than 0.02) in the rate of change for the R-R interval variation between the group with improved HbA1 by more than 5% and the group with aggravated HbA1 by more than 5%, when measured at intervals of 1 year. No special relationship was observed between the difference in R-R interval variation and each of the following: (1) the mean FBG for 1 year preceding the day of initial measurement of the R-R interval variation; (2) the mean FBG for the succeeding year; and (3) the difference in these 2. It was suggested that the R-R interval variation was likely to be affected by the metabolic state during the preceding 1-2 months.

Organic anion transport study in mutant rats with autosomal recessive conjugated hyperbilirubinemia.

The EHBR is a mutant rat strain with congenital conjugated hyperbilirubinemia bred from a Sprague-Dawley rat. Transport of conjugated bilirubin, indocyanine green, and tetrabromosulfophtalein from liver to bile is severely impaired in these rats. Serum bilirubin amounts to 6.0 +/- 0.05 mg/dl (n = 4) in adult rats, with 97% conjugates. The bile flow is reduced to about 65% of the control group, whereas total bile acid in 10-min bile samples is similar. Liver histology of 10 week-old rats revealed neither intracellular pigmentation nor architectural abnormalities.

Biological effects of Auger processes of bromine on yeast cells induced by monochromatic synchrotron X-rays.

The biological effects of inner-shell ionization in bromine atoms incorporated into DNA in the form of bromodeoxyuridine monophosphate (BrdUMP), induced by monochromatized synchrotron X-rays, were studied using a deoxythymidine monophosphate (dTMP)-permeable mutant of yeast, Saccharomyces cerevisiae. The BrdUMP-incorporated yeast cells were irradiated with monochromatic X-rays of 13.51 or 13.45 keV, between which the bromine K-absorption edge (13.47 keV) is located. The cells were 1.07 times more sensitive to irradiation by 13.51 keV X-rays than at 13.45 keV, while dTMP-incorporated cells did not show any difference in sensitivity. In the presence of a radioprotector during irradiation, BrdUMP-incorporated cells showed a larger enhancement (1.20). These enhancements observed in the bromine-incorporated cells cannot be explained only by an increase of the absorbed dose due to a substitution of CH3 group of thymine by bromine. It may be concluded that a major part of the enhancement was caused by inner-shell photoionization, followed by an Auger cascade of the bromine in the DNA. The quantum yield of lethality caused by the photoabsorption of bromine K-shell is not affected by the presence of cysteamine, suggesting the biological enhancement by the Auger processes may not be influenced by chemical protection.

Uracil-DNA glycosylase produces excess lethal damage induced by an Auger cascade in BrdU-labelled bacteriophage T1.

T1 phages with and without 5-bromo-2'-deoxyuridine (BrdU) labelling were irradiated in solids with monochromatic X-rays at 12.40 and 13.51 keV, below and just above the K-absorption edge of bromine (13.47 keV) in vacuum and wet states. Irradiated phages were assayed on uracil-DNA glycosylase (Udg) deficient (ung-1) and sufficient (ung+) host strains of Escherichia coli, in order to investigate the nature of the lethal damage induced by Auger cascade following X-ray absorption at the K-shell of bromine as a key atom. The results were: (1) An Auger-specific enhancement (1.15) was observed only when BrdU-labelled phages were irradiated in the wet state and assayed on ung+ host cells. (2) A Udg-specific enhancement was observed only for BrdU-labelled phages, not for unlabelled phages. (3) The sensitivities of BrdU-unlabelled phages were almost the same, despite the irradiation states and strains of the host cell, indicating that this sensitivity was a common fraction of the sensitivity under all conditions. (4) The lethal damage for the T1 phage was categorized into four fractions according to the sensitivities under different conditions: the general fraction was defined as being the sensitivity of unlabelled phages (G-fraction); BrdU-specific, but unrecognizable by Udg (B-fraction); Udg specific, but not Auger-specific (U-fraction); and Auger-specific (A-fraction). (5) Although the so-called indirect action of water radicals increased only the G-fraction by about three-fold, the B- and U-fractions were not affected by any change in the irradiation states, thus indicating that these two fractions were caused by the so-called direct action.

Effects of K-shell X-ray absorption of intracellular phosphorus on yeast cells.

The effects of K-shell absorption of phosphorus atoms on yeast cells were investigated using synchrotron X-rays that were tuned to the resonance absorption peak (2153 eV). Three types of cellular effect (cell inactivation, induction of gene conversion at the trp-5 locus, and cell membrane impairment (changes in the permeability] were measured. It was demonstrated that the enhancement factor was 1.4 at the resonance peak regarding both lethality and the induction of gene conversion in reference of off-peak irradiation (2146 and 2160 eV). No difference was found between the two off-peak irradiation energies. No cell membrane impairment was detected, irrespective of the X-ray photon energies employed within the fluence range tested. These results strongly suggest that K-shell X-ray absorption in the resonance mode by cellular phosphorus atoms causes significantly more cellular effects than the off-resonance mode of absorption, probably via some specific changes induced in the phosphates of the DNA strand. Calculations using the number of phosphorus atoms in a defined size of the trp locus (2127 base pairs) on the DNA and the absorption cross-section of the resonance mode of phosphorus showed that gene conversion is inducible at a rate of 0.13 per X-ray photon absorption per locus. These results are discussed regarding the modes of K-shell photoabsorption.

Single- and double-strand breaks in pBR322 plasmid DNA by monochromatic X-rays on and off the K-absorption peak of phosphorus.

Using a synchrotron irradiation system pBR322 plasmid DNA was irradiated under vacuum by monochromatic X-rays having five specific photon energies (2.147, 2.153, 2.159, 2.168 and 2.199 keV) both on and off the K-absorption peak (2.153 keV) of phosphorus. The single- and double-strand breaks (ssb and dsb) were measured as conversions of the closed circular form of DNA (form I) to open circular (form II) and linear (form III) forms respectively. Exposures to induce one strand break per molecule were lowest at the peak (2.153 keV), and highest at 2.147 keV; the ratios were 2.7 for ssb and 3.0 for dsb. The exposures for dsb were 21-26 times higher than those for ssb. When the exposures were converted to absorbed doses in grays the absorbed doses per ssb were almost independent of photon energy. This result indicates that a certain absorbed dose was necessary to induce a ssb, regardless of whether photons were absorbed by the K-shell of phosphorus or by other shells, or by other atoms. However, the absorbed dose per dsb at 2.147 keV was 1.17 times higher than that averaged over four X-ray energies above 2-153 keV, indicating that the K-shell absorption, and the subsequent Auger event, efficiently induce dsb. The results are also discussed concerning the number of photo-absorptions of the constituent atoms per DNA strand break.

Iron(II) sulphate (Fricke solution) oxidation yields for 8.9 and 13.6 keV X-rays from synchrotron radiation.

The oxidation yields (G) for 8.86 and 13.55 keV X-rays produced by synchrotron radiation were measured using an iron(II) sulphate (Fricke) solution. Monoenergetic X-rays were produced using a silicon crystal monochromator. The X-rays were absorbed in 0.4 M sulphuric acid-iron(II) sulphate solution and FeIII ion yields were measured and corrected for escape fractions resulting from scattering using Monte Carlo calculations. Doses in the solution were determined using a thin window, parallel plate chamber calibrated against a primary standard free-air chamber at the Electrotechnical Laboratory (Osaka, Japan). Yields (G) of 1.50 +/- 0.06 and 1.43 +/- 0.06 mumol J-1 were obtained for 8.86 and 13.55 keV X-rays respectively.

Induction of chromosome aberrations in human lymphocytes by monochromatic X-rays of quantum energy between 4.8 and 14.6 keV.

The induction of chromosome aberrations was studied in human peripheral blood lymphocytes irradiated in vitro with synchrotron-produced monochromatic soft X-rays of quantum energy in a range between 4.8 and 14.6 keV. These X-rays were more effective in producing chromosome aberrations (dicentrics and rings) than 60Co gamma-rays. The efficiency increased with increasing LET of the photoelectrons and their associated Auger electrons, reaching a maximum at a track average LET (L delta = 100, T) of around 4 keV/microns, and tended to decrease or become rather refractory with further increase of LET. This unique LET dependency was consistent with the dual nature of chromosome aberration formation, and interpreted as a reflection of a limited range of photoelectrons as compared with the size and intranuclear geometry of the elemental chromatin fibres as vehicles of damage interaction.

Enhanced killing effect on 5-bromodeoxyuridine labelled bacteriophage T1 by monoenergetic synchrotron X-ray at the energy of bromine K-shell absorption edge.

5-Bromo-2'-deoxyuridine labelled bacteriophage T1 was irradiated with monoenergetic X-rays obtained from synchroton radiation with the energies at 13.51 keV and 12.40 keV, just above and below the K-shell absorption edge (13.41 keV) of bromine, respectively. Phage samples were irradiated under three conditions, wet N2 gas, dry N2 gas and in vacuum, with water contents (g H2O/g sample) of 60, 2.6 and 0%. At 12.40 keV the D0 in kGy were 1.1 ("wet"), 1.9 ("dry") and 2.5 ("vacuum") for the Br-labelled phages and 1.6 ("wet"), 2.4 ("dry") and 6.2 ("vacuum") for unlabelled phages. The results clearly demonstrated that the X-ray sensitivities decreased with decrease in water contents. Br-enhancement ratios, ER = D0 (unlabelled)/D0 (Br-labelled), varied from 1.4 ("wet", 12.40 keV) to 2.5 ("vacuum", 13.51 keV). Auger enhancements which were defined by energy-dependent enhancement factor, Fen = [ER(13.51 keV)-ER(12.40 keV)]/ER(12.40 keV), were 0.09 +/- 0.09, 0.29 +/- 0.07 and 0.02 +/- 0.03 under "wet", "dry" and "vacuum" conditions, respectively. The change in Auger enhancement under "dry" condition in comparison with "wet" condition could be explained due to less of water. However the Auger enhancement decreased sharply under "vacuum" condition as the water content was zero. The reason for the sharp decrease in Auger enhancement under "vacuum" condition is difficult to understand. A possible explanation is discussed in the text.

Ca(2+)-activated K+ channel is present in guinea-pig but lacking in rat hepatocytes.

The mechanisms of norepinephrine-induced membrane responses in isolated hepatocytes from guinea-pigs and rats were compared using the suction-pipette, patch-clamp method, and intracellular Ca2+ concentration ([Ca2+]i) was measured using the Ca2+ fluorescent dye, Quin 2. The resting membrane potentials of isolated guinea-pig hepatocytes were -50 +/- 1 mV (mean +/- SD; n = 38), which is similar to that previously reported in rat hepatocytes by Sawanobori et al. (J Cell Physiol 139: 580-585, 1989). In guinea-pig hepatocytes, norepinephrine (6 microM) caused a membrane hyperpolarization, and norepinephrine (6 microM) or Ca(2+)-ionophore (A23187) (0.4 microM) caused a corresponding outward current. The sensitive current produced by norepinephrine and Ca(2+)-ionophore reversed its polarity at -74 +/- 9 mV (n = 7). The single channel recorded by cell-attached patch and inside-out patch had mean conductance of around 20 + 1 pS and was activated by 1 microM [Ca2+]i. On the other hand, neither norepinephrine (6-20 microM) nor Ca(2+)-ionophore (A 23187) (0.4 microM) caused any change in membrane potential and current in rat hepatocytes, whereas norepinephrine increased [Ca2+]i both in rat and guinea-pig hepatocytes to a similar degree. In the single-channel recording, we recorded single channels that had a mean conductance of 109.8 +/- 17.7 pS different from around 20 pS in guinea-pig. In inside-out patches, increased Ca2+ concentration from 10(-6) to 10(-3) M at the intracellular face of the membrane did not modify the single channel of rat hepatocytes. These results indicate that increased [Ca2+]i activates this channel in guinea-pigs, but that the channel activated by increased [Ca2+]i is lacking in rat hepatocytes membrane. Therefore, different mechanism operates in different species of liver cells to keep the constant state.

Hypervascular metastatic cardiac tumors: an unknown cause of mitral valve prolapse.

A 40-yr-old woman with alveolar soft-part sarcoma and multiple hypervascular cardiac tumors involving both left and right ventricles is reported. Papillary muscle dysfunction and mitral valve prolapse with mitral regurgitation were caused by the largest tumor in the left ventricle.