Benazepril conferred substantial renal benefits in patients without diabetes who had advanced renal insufficiency. (ClinicalTrials.gov number, NCT00270426.)

The Renoprotection of Optimal Antiproteinuric Doses (ROAD) study was performed to determine whether titration of benazepril or losartan to optimal antiproteinuric doses would safely improve the renal outcome in chronic renal insufficiency. . Uptitration was performed to optimal antiproteinuric and tolerated dosages, and then these dosages were maintained. Median follow-up was 3.7 yr. The primary end point was time to the composite of a doubling of the serum creatinine, ESRD, or death. Secondary end points included changes in the level of proteinuria and the rate of progression of renal disease. Compared with the conventional dosages, optimal antiproteinuric dosages of benazepril and losartan that were achieved through uptitration were associated with a 51 and 53% reduction in the risk for the primary end point (P ‫؍‬ 0.028 and 0.022, respectively). Optimal antiproteinuric dosages of benazepril and losartan, at comparable BP control, achieved a greater reduction in both proteinuria and the rate of decline in renal function compared with their conventional dosages. There was no significant difference for the overall incidence of major adverse events between groups that were given conventional and optimal dosages in both arms. It is concluded that uptitration of benazepril or losartan against proteinuria conferred further benefit on renal outcome in patients who did not have diabetes and had proteinuria and renal insufficiency.

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Study Objectives: To explore the regional brain activities in patients with chronic primary insomnia (PCPIs) and their sex differences. Methods: Forty-two PCPIs (27 females, 15 males) and 42 good sleepers (GSs; 24 females, 18 males) were recruited. Six PCPIs (3 males, 3 females) were scanned twice by MRI to examine the test-retest reliability. Amplitude of low frequency fluctuation (ALFF) method was used to assess the local brain features. The mean signal values of the different ALFF areas were analyzed with a receiver operating characteristic (ROC) curve. Simple linear regression analysis was performed to investigate the relationships between clinical features and different brain areas. Results: Both female and male PCPIs showed higher ALFF in the temporal lobe and occipital lobe, especially in female PCPIs. Female PCPIs had lower ALFF in the bilateral cerebellum posterior lobe, left dorsolateral prefrontal cortex, and bilateral limbic lobe; however, male PCPIs showed lower ALFF in the left occipital gyrus. The mean signal value of the cerebellum in female PCPIs showed negative correlations with negative emotions. Compared with male PCPIs, female PCPIs showed higher ALFF in the bilateral middle temporal gyrus and lower ALFF in the left limbic lobe. The different areas showed high testretest stability (Clusters of contiguous volumes ≥ 1080 mm 3 with an intraclass correlation coefficient ≥ 0.80) and high degree of sensitivity and specificity. Conclusions: Female PCPIs showed more regional brain differences with higher and lower ALFF responses than male PCPIs. However, they shared analogous excessive hyperarousal mechanism and wide variations in aberrant brain areas. I NTRO DUCTI O NPatients with chronic primary insomnia (PCPIs), who underwent the subjective experience of chronically disturbed sleep, sleep loss, non-refreshing sleep, and heightened arousal in bed with impaired quality of life, showed a decreased ability to disengage from external information processing at sleep onset.1-3 Occasional episodes of insomnia symptoms are reported in half of all adults, while chronic insomnia is prevalent in 10-15% of the adult population. 4 In spite of a recent increase in neuroimaging research into PCPIs, it has not gleaned a consistent conclusion about its neuropathology after reviewing the neuroimaging studies of primary insomnia, especially with regard to the structural studies of brain alterations. 5 The results of structural studies are either contradictory or required replication. Altena et al. found that PCPIs had a smaller volume of reduced gray matter in the precuneus and left orbitofrontal cortex which strongly correlated with the subjective severity of insomnia, but increased gray matter volume was not found. 6 Joo et al. demonstrated significantly reduced gray matter concentrations in the dorsolateral prefrontal and pericentral cortices, superior temporal gyrus, and cerebellum, and decreased gray matter volumes in the medial frontal lobe and middle temporal lobe in PCPIs compared with good sleepers (GSs), ...

To evaluate the role of the renin gene in the development of hypertension in Dahl salt-sensitive rats (SS/Jr/Hsd), we derived a congenic strain of rats homozygous for the salt-resistant renin allele (S/renrr) and compared them with a control strain homozygous for the salt-sensitive renin allele (S/ren(ss). Mean arterial pressure was significantly higher in 12-week-old S/renrr rats fed a high salt (8.0%) diet for 3 weeks than in S/ren(ss) rats or in SS/Jr/Hsd rats rederived from the foundation colony we used to generate the cogenic strain (195 +/- 3 [n = 49] versus 168 +/- 3 [n = 17] or 161 +/- 3 [n = 16] mm Hg). Mean arterial pressure was also higher in S/renrr rats than in S/ren(ss) rats raised from birth on either a very low salt (0.1%) diet (119 +/- 9 [n = 6] versus 100 +/- 7 [n = 7] mm Hg) or a low salt (0.4%) diet (143 +/- 1 [n = 22] versus 117 +/- 3 [n = 10] mm Hg). Plasma renin activity of S/renrr rats was significantly higher than that of S/ren(ss) rats fed a very low salt diet (5.7 +/- 2.0 versus 1.8 +/- 0.3) ng angiotensin l/mL per hour), a low salt diet (4.4 +/- 1.0 versus 1.1 +/- 0.3), or a high salt diet (1.5 +/- 0.2 versus 0.9 +/- 0.1). Urinary protein excretion was greater in S/renrr rats than in S/ren(ss) rats fed a high salt diet (244.2 +/- 48.5 versus 43.6 +/- 19.5 mg/24 h), and this was associated with significant reductions in renal blood flow (3.3 +/- 0.6 versus 4.6 +/- 0.5 mL/min per gram kidney weight) and glomerular filtration rate (0.49 +/- 0.11 versus 0.82 +/- 0.08 mL/min per gram kidney weight). Captopril (20 mg/kg i.v.) had no effect on blood pressure in S/ren(ss) rats fed a low salt diet, but it lowered blood pressure by 20 mm Hg in S/ren(rr) rats to the same level seen in untreated S/ren(ss) rats. Chronic administration of captopril (5 mg/100 mL drinking water) reduced blood pressure in S/renrr rats fed a high salt diet (170 +/- 5 mm Hg) to the same level seen in untreated S/ren(ss) rats, whereas it had no significant effect on blood pressure in S/ren(ss) rats. These results indicate that transfer of a salt-resistant renin allele to SS/Jr/Hsd rats raises plasma renin activity and augments the severity of hypertension and renal disease.

Background: Among discharged COVID-19 patients, the health-related quality of life is poor, and patients suffer from significant physical and psychological impairment. This study was designed to investigate the effects of Liuzijue exercise on the rehabilitation of COVID-19 patients. Methods: Thirty three eligible patients with COVID-19 were enrolled in the study after discharge. All the participants practiced Liuzijue exercise once per day for 20 minutes over 4 weeks. Data were collected at baseline and the end of the intervention. Primary outcomes involved functional capacity and secondary outcomes involved quality of life. Results: The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), and diaphragm movement in deep breathing (DM-DB) of patients increased significantly after 4 weeks of intervention. The dyspnea was also alleviated and exercise capacity was significantly improved. In terms of quality of life, physical functioning and role-physical scores were significantly increased. Moreover, Liuzijue could significantly alleviate the depression and anxiety status of the patients. Conclusion: Liuzijue exercise is a viable alternative home exercise program that produced better functional capacity and quality of life in discharged patients with COVID-19. These findings also showed the necessity of rehabilitation intervention for cured COVID-19 patients.

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Nishikawa, K. (2012). Phylogenetic and taxonomic relationships of the Polypedates leucomystax complex (Amphibia). -Zoologica Scripta, 42, 54-70. We investigated the phylogenetic and taxonomic relationships and estimated the history of species diversification and biogeography in the Asian rhacophorid genus Polypedates, focusing on the Polypedates leucomystax complex, whose members are notoriously difficult to classify. We first estimated phylogenetic relationships within the complex using 2005-bp sequences of the mitochondrial 12S rRNA, tRNA val and 16S rRNA genes with maximum parsimony, maximum likelihood (ML) and Bayesian methods of inference. Polypedates exhibits well-supported monophyly, with distinct clades for P. otilophus, P. colletti, P. maculatus and the P. leucomystax complex, consisting of P. macrotis, and the Malay (Polypedates sp. from Malay Peninsula), North China (P. braueri), South China (Polypedates cf. mutus 1), Indochina (P. megacephalus), Sunda (P. leucomystax) and Laos (Polypedates cf. mutus 2) clades. In a subsequent phylogenetic analysis of 4696-bp sequences of the nuclear brain-derived neurotrophic factor (BDNF), sodium ⁄ calcium exchanger 1 (NCX), POMC, Rag-1, Rhod and Tyr genes using Bayesian methods of inference, all of these clades were recovered. Some clades of the P. leucomystax complex occur sympatrically and show high genetic diversity or morphological and acoustic differences. Similar tendencies were observed between some allopatric clades. Therefore, we consider each of these groups to be distinct specifically. We also estimated absolute divergence times within the genus using Bayesian methods. Divergence in Polypedates began with the divergence of a primarily South Asian Clade from the common ancestor of secondarily South-East Asia P. maculatus and South-East Asian members. The divergence between the latter occurred much later. The P. leucomystax complex diverged in the Pliocene, much later than other congeners, and seems to have been greatly affected by human-related dispersal after the Pleistocene.