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MADIT-CRT Trial Meets Primary Endpoint
Boston Scientific Corporation (NYSE: BSX) and the University of Rochester Medical Center announced that the landmark MADIT-CRT trial has met its primary endpoint. Preliminary results show Boston Scientific cardiac resynchronization therapy defibrillators (CRT-Ds) to be associated with a significant 29 percent reduction (p=0.003) in death or heart failure interventions when compared to traditional implantable cardioverter defibrillators (ICDs). High risk(1), asymptomatic or mildly symptomatic, New York Heart Association (NYHA) Class I and II(2) patients were enrolled in MADIT-CRT. The MADIT-CRT Executive Committee expects to present and publish the trial"s full results later this year.
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CBO Report Details Budgetary Treatment Of Health Reform
A mandate requiring all U.S. residents to purchase health coverage would not be considered a new form of federal taxation as long as people could choose from a wide variety of private plans and no government entity was responsible for collecting their premiums, according to a Congressional Budget Office report released on Wednesday, the Washington Post reports. CBO Director Douglas Elmendorf in his blog wrote, "In CBO"s view, the key consideration is whether a proposal would be making health insurance an essentially governmental program, tightly controlled by the federal government, ... or whether the system would provide significant flexibility in terms of the types, prices and number of private-sector sellers of insurance available to people." He continued, "The former -- a governmental program -- belongs in the federal budget (including all premiums paid by individuals and firms to private insurers), but the latter -- a largely private-sector system -- does not." Elmendorf wrote, "Premium income -- for a public plan (or plans) and for insurance purchased through exchanges or in the private market -- should be classified as federal revenues if there is an individual mandate and tight government control of the insurance market." However, income from premiums should not appear in the federal budget "if there is no mandate and no public plan, or there is an individual mandate and an active, loosely restricted private market, and if premiums are paid through nongovernmental exchanges or directly to insurers."CBO in 1994, when lawmakers were considering the Clinton administration"s health reform proposal, concluded that a proposed requirement that employers and employees make payments into government-run insurance pools would constitute a form of taxation and a major expansion of the federal government (Montgomery, Washington Post, 5/28).
News of the day
RCP's Response To Lord Darzi's Report, High Quality Care For All, Our Journey So Far.
Responding to the publication of High Quality Care for All, Our journey so far, Professor Ian Gilmore, President of the Royal College of Physicians, said
Oncology

Are Angiotensins Involved In The Hemodynamic Changes Of Cirrhosis Patients?

Liver cirrhosis has been recently studied in the light of the new view of the renin angiotensin system (RAS). While the angiotensin converting enzyme (ACE)-Ang 2-AT1 receptor arm contributes to liver tissue injury and fibrosis and the maintenance of basal vascular tonus in non-compensated cirrhosis, the activation of the ACE2-Ang-(1-7)-Mas receptor arm exerts anti-fibrotic actions and probably has also a role in arterial vasodilation in liver cirrhosis. In a previous study published last year in WJG by the same research group, it was shown that chronic treatment with propranolol in cirrhotic patients was characterized by marked changes in the precursors of the RAS cascade (renin and Ang 1 with repercussions on the 2 main RAS components, Ang 2 and Ang-(1-7), in the splanchnic and peripheral circulation. Therefore, the circulating profile of RAS components at different stages of liver cirrhosis and their role in hemodynamic changes of cirrhosis remained unclear. A research article published in the World Journal of Gastroenterology addressed this issue. The research team led by Prof. Santos from the Federal University of Minas Gerais measured the circulating levels of angiotensins in patients at different stages of liver cirrhosis by radioimmunoassay, and further evaluated the influence of RAS components on hemodynamic changes during liver transplantation. The study showed that the progression of liver dysfunction is characterized by marked changes in circulating Ang-(1-7) and Ang 2 levels. In the initial stages, there were a predominance of Ang-(1-7) rather than Ang 2. On the other hand, advanced stages of cirrhosis showed an activation of the peripheral and splanchnic RAS, and a deviation toward the formation of Ang-(1-7) in the splanchnic circulation. Furthermore, there was a positive correlation between the Ang-(1-7)/Ang 2 ratio and cardiac output and a negative correlation between this ratio and systemic vascular resistance, indicating that the final functional effects of the RAS may reflect a balance between these 2 opposing peptides. The relationship between Ang-(1-7) and Ang 2 may play a role in hemodynamic changes of human cirrhosis. The peptide Ang-(1-7) probably predominates in the peripheral circulation in the initial stages of human cirrhosis and in the splanchnic circulation in the advanced stages, both contributing to a reduction in vascular resistance and consequently to hyperdynamic circulation. In the peripheral circulation of patients with advanced cirrhosis, when compared to the splanchnic circulation, Ang 2 probably leads to extra-splanchnic vasoconstriction. Although further studies with a larger number of patients should address the precise role of RAS in human cirrhosis, this research opens the possibility that future therapies interfering with the RAS in both the systemic and splanchnic circulation should lead to more success in the management of the hemodynamic changes in human cirrhosis. Reference: Vilas-Boas WW, Ribeiro-Oliveira Jr A, Pereira RM, Ribeiro RC, Almeida J, Nadu AP, Simēµes e Silva AC, Santos RAS. Relationship between angiotensin-(1-7) and angiotensin 2 correlates with hemodynamic changes in human liver cirrhosis. Correspondence to: Robson Augusto Souza dos Santos, Laboratory of Hypertension, Department of Physiology, Biological Sciences institute, Federal University of Minas Gerais, Av. Antonio Carlos, 6627, Belo Horizonte, MG, 31270-901, Brazil. Lai-Fu Li World Journal of Gastroenterology


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