Impact of swimming exercise on inflammation in medullary areas of sympathetic outflow control in spontaneously hypertensive rats.

Exercise reduces sympathetic activity (SA), arterial pressure and heart rate in spontaneously hypertensive rats (SHR). Exercise increases oxidative stress (OS) and inflammation is implicated in the generation of reactive oxygen species (ROS) and progression of hypertension. To unravel these effects of exercise and considering that SA is driven by medullary areas, we hypothesized that swimming exercise (SW) affects the gene expression (g.e.) of proteins involved in inflammation and OS in the commissural Nucleus of the Solitary Tract (cNTS) and Rostral ventrolateral medulla (RVLM), which control the sympathetic outflow in SHR. We used male SHR and Wistar rats (14-16wks-old) which were maintained sedentary (SED) or submitted to SW (1 h/day, 5 days/wk./6wks). The g.e. of cycloxygenase-2 (COX-2), interleukin 6 (IL-6), interleukin 10 (IL-10), AT-1 receptor (AT-1r), neuroglobin (Ngb) and cytoglobin (Ctb) in cNTS and RVLM was carried out by qPCR. We observed that COX-2 g.e. increased in SW-SHR in cNTS and RVLM compared to SED-SHR. The IL-6 g.e. reduced in RVLM in SW-SHR, whereas IL-10 g.e. increased in SW-SHR in comparison to SED-SHR. The AT-1r g.e. decreased in SW-SHR in cNTS and RVLM compared to SED-SHR. The Ngb and Ctb g.e. in cNTS neurons increased in SHR and Wistar rats submitted to SW compared to SED, but only Ctb g.e. increased in RVLM in SW-SHR and Wistar in comparison to SED. Therefore, the SW altered the g.e. in cNTS and RVLM for reducing the inflammation and ROS formation, which is increased particularly in SHR, consequently decreasing the OS.

Use of unnecessary medications by patients with advanced cancer: cross-sectional survey.

BACKGROUND: Cancer patients at the end of life take numerous medications. However, it has not been assessed what proportion of patients take unnecessary medications and which patients are at risk for doing so. METHODS: Cross-sectional survey of medications utilized by terminally ill ambulatory cancer patients, with the aim of identifying medications considered unnecessary as per explicit criteria. The criteria took into account whether drugs could benefit patients with terminal cancer. RESULTS: Among 87 patients, 21 (24%, 95% confidence interval [CI] 15.6-34.5%) were taking at least one unnecessary medication, the most common being gastric protectors. In multivariable analyses, patients with Charlson Comobidity Index≤1 (OR: 4.49, CI95% 1.32-15.26; p=0.01) or whose medication list had not been reconciled by physicians (OR: 6.38, CI95% 1.21-33.40; p=0.02) were more likely to use an unnecessary medication. CONCLUSION: Patients with advanced cancer take many medications considered unnecessary. Medication reconciliation should be performed routinely for these patients.