Centrally acting antihypertensives and alpha-blockers in people at risk of falls: therapeutic dilemmas-a clinical review.

PURPOSE: The aim of this clinical review was to summarise the existing knowledge on the adverse effects of alpha-blockers and centrally acting antihypertensives, the effect these may have on falls risk, and guide deprescribing of these medications. METHODS: Literature searches were conducted using PubMed and Embase. Additional articles were identified by searching reference lists and reference to personal libraries. We discuss the place of alpha-blockers and centrally acting antihypertensives in the treatment of hypertension and methods for deprescribing. RESULTS: Alpha-blockers and centrally acting antihypertensives are no longer recommended for the treatment of hypertension unless all other agents are contraindicated or not tolerated. These medications carry a significant falls risk and non-falls risk-associated side effects. Tools to aid and guide de-prescribing and monitoring of the withdrawal of these medication classes are available to assist the clinician including information on reducing the risk of withdrawal syndromes. CONCLUSIONS: Centrally acting antihypertensives and alpha-blockers increase the risk of falls through a variety of mechanisms-principally by increasing the risk of hypotension, orthostatic hypotension, arrhythmias and sedation. These agents should be prioritised for de-prescribing in older frailer individuals. We identify a number of tools and a withdrawal protocol to aid the clinician in identifying and de-prescribing these medications.

Fracture risk is under-recognised and under-treated in memory clinic attendees.

UK national guidelines recommend that older people at risk of falling should have their fracture risk assessed and acted upon. People with cognitive impairment are more likely to sustain a fracture than their cognitively intact peers. We assessed the fracture risk of 79 memory clinic attendees and compared their actual management with guidelines. Despite reporting 57 falls in the last year, only 36% of those who would be recommended antiresportive treatment were prescribed it and a dual-energy X-ray absorptiometry (DEXA)scan was performed in only 13% where it would be recommended. These findings highlight an important deficit in fracture risk assessment which should inform future interventions.

Irradiation biology of male brown marmorated stink bugs: is there scope for the sterile insect technique?

PURPOSE: Brown marmorated stink bugs, Halyomorpha halys Stål (Hemiptera: Pentatomidae), are regularly intercepted, but there are few eradication tools. Currently, no sterile insect technique program exists for Hemiptera. MATERIALS AND METHODS: Adult males were irradiated at 4-60 Gy, mated and their progeny reared for two generations, with mortality assessed at F1 egg, F1 adult and F2 egg stages. RESULTS: The F1 eggs showed a dose response to irradiation between 4 and 36 Gy, with 97% sterility at 16 Gy, and higher doses producing complete egg mortality. Only rare F1 survivors had progeny, but the F2 generation showed identical responses between maternal and paternal lines; most egg batches showed either very low or very high mortality. Irradiation with 16 Gy resulted in 98.5% sterility, cumulative over F1 and F2. CONCLUSIONS: Lack of a dose response at the F2 generation precludes the use of irradiation-induced inherited sterility. The conventional sterile insect technique appears possible by irradiation of males from ∼12 to 16 Gy. The effect of radiation dose on females is not known, thus we cannot conclude whether bi-sex release is feasible so for now the release of males only is recommended. More work is needed on the competitive fitness of irradiated males, and logistics such as mass rearing or field collection, in order to determine the feasibility of the approach.

Kidney and spleen twin grafts in rats: unidirectional graft acceptance in unsuppressed ACI recipients.

In previous studies, we have shown that vascularized spleen grafts can facilitate the acceptance of simultaneously implanted hearts, especially if host splenectomy is done 3 days later. The present study shows that the same protocol works not only for hearts but also for kidneys. A total of 59 renal allografts were carried out in various combinations between LEW and ACI rats. The recipients were submitted to bilateral nephrectomy at the time of graft implantation and host splenectomy 3 days later. Graft function was assessed by survival time of the animals. In addition, BUN, creatinine, and hematocrit were measured in selected individuals. The following observations were made: 1) LEW kidneys were rejected at 92 +/- 65 days while ACI kidneys failed at 17 +/- 1.4 days (p less than 0.025). 2) Control animals without simultaneous syngenic functioning spleen implant rejected their LEW kidneys at 30.6 +/- 24.3 days (p less than 0.005). 3) Eleven rats never rejected their LEW kidneys (four single, seven twin grafts). 4) BUN, creatinine, and hematocrit differed significantly in rats with functioning kidneys compared to those in end stage renal failure (p less than 0.0005, p less than 0.0025, and p less than 10(-7) respectively). It is concluded that the presence of the donor spleen can facilitate the acceptance of a simultaneous kidney graft to various degrees, depending on the strain combination.

Malignant nephroblastoma in Macaca fascicularis.

A case of malignant nephroblastoma was identified in a 4.5-month-old female Macaca fascicularis. The age of onset, clinical history, gross and microscopic pathology, and the pulmonary metastasis were analogous to this condition as seen in man.

Acute gastric dilatation in monkeys: a microbiologic study of gastric contents, blood and feed.

Twenty-one of 24 simian primates with acute gastric dilatation had Clostridium perfringens in their gastric contents. Only 2 of 18 normal animals contained this organism in their gastric contents. Clostridium perfringens was isolated from monkey biscuits taken from the cages of five affected animals and from five of 11 incoming lots of feed. After these biscuits were fed to normal animals, this organism could be isolated from the gastric contents. There were no other organisms isolated which could account for the voluminous gas production in this condition.

Development of a reversible vas deferens occlusion device. VII. Physical and microscopic observations after long-term implantation of flexible prosthetic devices.

Flexible prosthetic devices developed previously to reversibly block sperm transport through the vas degerens were implanted in the vasa deferentia of dogs or kept in a semen bath for a 6-month period. Dimensional measurements, flow characteristics, leakage tests, and detent action force tests to displace the valve stem were performed with the valves. No changes occurred in any of these parameters with the exception of a decrease in the force required to change the position of the valve stem. This explains the occasional passage of spermatozoa through certain closed devices after they have been implanted for long periods of time. Histologic studies indicated that the same types of genital tract changes are associated with an implanted device as with vasectomy, and that they occur with approximately equal frequencies. Scanning electron microscope studies showed (1) excellent tissue ingrowth into the Dacron velour material of the implanted device; (2) the build-up of material, consisting in part of spermatozoa, in the device lumen and on the value stem; and (3) the absence of surface degradation of either the Silastic material or the valve stem of the device. It is concluded that no irreversible tissue damage is caused by the long-term implantation of flexible prosthetic devices into the vas deferens.