Long-Term Drug Treatment of Obesity in a Private Practice Setting

ATKINSON, RICHARD L, ROY C BLANK, DONALD SCHUMACHER, NIKHIL V DHURANDHAR, DOUGLAS L RITCH. Long-term drug treatment of obesity in a private practice setting. This study evaluated the long-term efficacy and safety of the combination of phentermine and fenfluramine for the treatment of obesity in a private practice setting. A total of 1388 consecutive, qualified patients presenting to a private general internal medicine practice in Charlotte, NC, were enrolled with eligibility criteria including: age 18 years to 60 years, 20% over “desirable” bodyweight or body mass index <27, no serious medical or psychiatric disease, and no contraindications to drug therapy. Patients were instructed in diet, exercise, and behavior modification techniques and received phentermine (15 mg/day to 30 mg/day) and fenfluramine (20 mg/day to 60 mg/day) continuously for over 3 years. Average duration of treatment was 15. 9 months, and average weight loss at the last visit was 11. 6 kg, or 11. 7% of initial bodyweight. For patients completing 1 year of drug treatment, mean weight loss was 16. 5 kg, or 16% of initial weight. Weight loss persisted for 2 years, but partial regain was seen at 3 years. The dropout rates were 18% at 6 months, 39% at 1 year, 68% at 2 years, and 78% at 3 years. At 1 year, blood pressure of hypertensive patients fell from 151/95 mm Hg to 127/78 mm Hg, and serum cholesterol and triglycerides of hyperlipidemic patients fell by 0. 750 mmol/L (29 mg/dL) and 0. 937 mmol/L (83 mg/dL), respectively. Adverse events were modest. We conclude that, in a private practice setting, long-term treatment of obesity with the combination of phentermine, fenfluramine, and a weight maintenance program is generally safe and effective. More research is needed to determine efficacy and safety for longer than 3 years.     

内皮素－1对缺氧肺动脉平滑肌细胞的增殖作用

内皮素（ＥＴ）是至今所发现的最强的内源性血管收缩肽,近年来发现ＥＴ－１能促进血管平滑肌细胞增殖。本研究表明ＥＴ－１对缺氧培养的肺动脉平滑肌细胞（ＰＡＳＭＣ）有剂量依赖的增殖作用,缺氧可促进ＰＡＳＭＣ的ＤＮＡ合成且增加ＥＴ－１的丝裂原作用。ＥＴ－１的丝裂原作用主要由其Ａ型受体（ＥＴＲ＿Ａ）所介导,ＥＴＲ＿Ａ的特异拮抗剂ＢＱ１２３可显著抑制缺氧以及缺氧与ＥＴ－１协同所产生的增殖作用,而且发现ＥＴＲ＿Ａ在缺氧培养的ＰＡＳＭＣ中的表达显著高于常氧对照组ＰＡＳＭＣ。本研究表明ＥＴ－１参与了缺氧性肺动脉结构重组,而缺氧可增强ＰＡＳＭＣ对ＥＴ－１的增殖反应性。     

In vitro autoradiographic localization of [I]-angiotensin II binding sites in the rat and dog kidney

Light microscopic autoradiographic techniques have been utilized to demonstrate specific regions of the rat and dog kidney where angiotensin II receptors exist. Slide mounted tissue sections were labeled with [¹²⁵I]-angiotensin II using conditions which provided for highly specific binding. These angiotensin II binding sites were localized to several distinct renal structures. In the renal cortex, angiotensin II binding sites were found concentrated in all parts of the glomeruli including the vascular components, the macula densa and the juxtaglomerular apparatus. Angiotensin II binding in the medulla was more diffusely associated with the vasa recta, and to a lesser extent, the thick ascending segment of the loop of Henle. Binding sites specific for angiotensin II were also found in the smooth muscle laminae of the ureter. Scatchard analysis of the binding kinetics allowed the demonstration of two subpopulations of binding sites which differ slightly in their affinities for [¹²⁵I]-angiotensin II. These subpopulations appear to be associated with distinct components of the renal structure.     

Central neural peptides and catecholamines in spontaneous and DOCA/salt hypertension

Hypothalamic and neurophypophyseal levels of catecholamines and peptides were measured in spontaneous and deoxycorticosterone (DOCA)/salt hypertension. Catecholamines, norepinephrine, epinephrine and dopamine were measured by electrochemical detection while the peptides, vasopressin, oxytocin, luteinizing hormone-releasing hormone (LHRH), the enkephalins and somatostatin (SRIF) were measured by radioimmunoassay. Blood pressure was significantly elevated in both groups as compared to their controls. Marked changes in central neural peptides were observed in the SHR, while no differences were seen in DOCA/salt hypertension. Hypothalamic vasopressin, oxytocin, LHRH and SRIF were significantly decreased. In the posterior pituitary, enkephalins were increased twofold in the SHR. With regard to catecholamines, there was no change in hypothalamic content. However, a dramatic decrease in neurohypophyseal dopamine was observed in SHR. Plasma levels of vasopressin were significantly elevated in both types of hypertension while oxytocin was increased only in the DOCA/salt model. These result show that (1) a wide spectrum of neuroendocrine changes are associated with genetic hypertension, (2) there are CNS differences between DOCA/salt and spontaneous hypertension, and (3) central aminergic changes may be involved in th neuroendocrine alterations seen in the SHR.     

Effect of cholesterol and dipalmitoyl phosphatidylcholine enrichment on the kinetics of Na−Li exchange of human erythrocytes

Summary The effects of cholesterol loading and depletion and of a 10% replacement of native phosphatidylcholine by dipalmitoyl phosphatidylcholine (di 16:0-PC) on kinetic properties of human red cell Na–Li exchange have been studied.Compared to control erythrocytes (cholesterol/phospholipid ratio (C/P=0.8–0.9)),V _max of phloretin-sensitive Li uptake and of Li efflux stimulated by extracellular Na (Na _o ) were reduced by 15–30% in cholesterol-loaded red cells (C/P=1.05–1.33). The apparentK _m values for external Li (Li _o ) and for internal Li (Li _i ) were decreased by about one-third in these cells. Cholesterol depletion (C/P=0.7) exerted opposite effects on the kinetics of Na _o -dependent Li efflux. On augmentingC/P from 0.66 to 1.0,V _max of Na _o -dependent Li efflux was reduced by about 30%; increasingC/P above 1.0 caused no further lowering ofV _max. Li leakage rates monotonically decreased over the whole range ofC/P ratios examined (0.66–1.3). This indicates that Na–Li exchange and Li leak are differentially affected by cholesterol.Incorporation of di 16:0-PC (replacement of 3% of total red cell phospholipids) caused similar kinetic alterations of Na–Li exchange as a rise in membrane cholesterol by 20–50%. Notably, selective incorporation of di 16:0-PC into the outer monolayer increased both intra- and extracellular Li binding affinities of Na–Li exchange and lowered its maximum velocity. Thus, both di 16:0-PC enrichment and cholesterol loading exerted an uncompetitive type of transport inhibition. The results are in agreement with the hypothesis that the kinetic alterations of red cell Na–Li exchange seen in a subgroup of essential hypertensive patients could be due to subtle changes in the molecular species composition of individual phospholipids.     

原发性高血压患者红细胞中存在抗高血压因子

本研究利用热处理和Sephadex G-150凝胶过滤层析等方法,从原发性高血压病患者(EHS)红细胞中部分纯化了抗高血压因子(AHF)。AHF具有热稳定性,分子量大于6kDa;能明显降低卒中易感型自发性高血压大鼠(SHR_(sp))血压,腹腔一次注入AHF(1.6mg/kg)30min后,SHR_(sp)收缩压从原来的27.6±0.7kPa降低到21.4±0.8kPa(p<0.001),4h后收缩压恢复至原水平。AHF能显著抑制自发性高血压大鼠(SHR)和肾性高血压大鼠(RHR)主动脉(A)及肠系膜动脉(MA)血管平滑肌(VSM)Ca~(2 )内流。且对MA Ca~(2 )内流的抑制作用强于A。以上结果表明:EHS红细胞中存在AHF,能显著降低高血压大鼠血压,其降压机制可能与其抑制VSM特别是小动脉VSM Ca~(2 )内流有关。     

Selenium and blood pressure studies in young and adult normotensive,renal, and spontaneously hypertensive animals

With reports of either no change or reduction of blood pressure, the relationship between selenium and blood pressure has not been clear. Normal Se values are not available for the Sprague Dawley (SD) rat or in the young and adult rat with various models of experimental hypertension. This study measured serum Se levels in the young and adult normotensive (NT), Grollman renal hypertensive (RH), and Okamoto-Aoki spontaneous hypertensive rats (SHR). The young animals have statistically significant (P<0.001) lower Se values as measured by the fluorometric method than those found at adulthood. Selenium levels were found to be altered in the adult SHR animals when compared with the RH and NT animals. The serum Se value for the normotensive SD rat was found to be 65.0±3.5 μg/dL, and for the two experimental models, 63.7±4.6 μg/dL for the RH, whereas the SHR level was elevated to 75.04±4.8 μg/dL (P<0.001). Elevated serum Se values in the adult SHR animals suggests an altered metabolism in SHR animals.     

Alterations in the phosphodiesterase type 5 pathway and oxidative stress correlate with erectile function in spontaneously hypertensive rats

To explore how alterations in the phosphodiesterase type 5 (PDE5) signalling pathway and oxidative stress correlate with changes in the expression of relaxation and contraction molecules and erectile dysfunction (ED) in the corpus cavernosum smooth muscle (CCSM) of spontaneously hypertensive rats (SHR). In this study, SHR and Wistar‐Kyoto (WKY) rats were used. Erectile function was determined by apomorphine test and electrical stimulation (ES) of cavernous nerve. Masson''s trichrome staining and confocal microscopy were performed. Nitric oxide synthase (NOS), PDE5, phosphorylated‐PDE5 and α1‐adrenergic receptor (α1AR) were determined by RT‐PCR and Western blotting while oxidative stress in CC was determined by colorimetric analysis. SHR exhibited obvious ED. CC of SHR showed less SM but more collagen fibres. The expression of NOS isoforms in SHR was significantly decreased while all α1AR isoforms were increased. In addition, PDE5 and phosphorylated‐PDE5 were down‐regulated and its activity attenuated in the hypertensive rats. Meanwhile, the SHR group suffered oxidative stress, which may be modulated by endoplasmic reticulum stress and NADPH oxidase up‐regulation. Dysregulation of NOS and α1AR, histological changes and oxidative stress in CC may be associated with the pathophysiology of hypertension‐induced ED. In addition, PDE5 down‐regulation may lead to the decreased efficacy of PDE5 inhibitors in some hypertensive ED patients and treatment of oxidative stress could be used as a new therapeutic target for this type of ED.     

Focus: Preventive Medicine: Undiagnosed Hypertension and Undiagnosed Type 2 Diabetes among Overweight and Obese Marshallese Participants in a Diabetes Prevention Program

Hypertension and type 2 diabetes (T2D) are major public health issues that disproportionately affect minority communities, including Native Hawaiians and Pacific Islanders (NHPI). Minority communities are also more likely to have undiagnosed hypertension and T2D. Marshallese Pacific Islanders have been shown to have high proportions of diagnosed and undiagnosed hypertension and T2D. Using survey and biometric data collected from 378 overweight/obese Marshallese Pacific Islander adults, this study documents the prevalence of hypertension and T2D, as well as the prevalence of undiagnosed hypertension and T2D. The study also examines associations between undiagnosed hypertension and undiagnosed T2D and age group, sex, health care access (defined by foregone care due to cost and health insurance status), and body mass index (BMI). Among participants with blood pressure readings indicative of hypertension, 68.4% were undiagnosed, and among participants with HbA1c indicative of T2D, 31.6% were undiagnosed. A quarter of participants (24.5%) had blood pressure and HbA1c measures indicative of both undiagnosed hypertension and undiagnosed T2D. Undiagnosed hypertension was significantly associated with age group (p’s<0.0001) and sex (p=0.028). Undiagnosed T2D was significantly associated with age group (p’s<0.05), forgone care due to cost (p=0.018), health insurance status (p=0.035), and BMI (p=0.001). Participants in this study had high proportions of undiagnosed hypertension and undiagnosed T2D. These findings will be immediately useful for those working to address hypertension and T2D disparities among Marshallese and other NHPI populations.