Acetylsalicylic Acid Treatment Research Articles

Comparison of the Safety Effects of Antiplatelets on the Kidneys in Patients with Vascular Disease

Aims: Most vascular disorders fall under the category of inflammatory diseases because they gradually harm blood vessels, disrupting the normal flow of blood to and from vital organs. The purpose of this research was to determine the potential dangers to kidney health associated with acetylsalicylic acid and clopidogrel treatment in patients with vascular diseases. Methodology: A cross-sectional research design was employed in the study, as well as retrospective data collection methods on medical records, and purposive sampling-based data sampling methodologies. Results: The study's findings indicated that there was no significant correlation between the use of antiplatelets and the risk of developing kidney disorders. It is rather, a patient's lifestyle, use of medications that increase the risk of renal GFR, and co-occurring diseases that may impair blood flow in the renal afferen can all increase their risk of developing a renal disorder with p-value <0.05. Nevertheless, the prolonged use of medication also plays a significant role in kidney function. The study's results indicate that renal problems are not attributed to the usage of antiplatelet drugs such as clopidogrel and acetylsalicylic acid. Scientific Novelty: Several using antiplatelet for indicated cardiovascular disease such us, atherosclerosis, plaque formation, endothelial dysfunction, and blockage or damage to the vascular endotelial matrix are all symptoms of vascular disease, a progressive inflammatory illness, it's frequently associated with the risk of kidney disorders. The use of antiplatelet will enlarge the afferent blood vessels. Conclusion: Instead, factors such as a patient's lifestyle, the severity of their condition, and their medical history could have a more significant impact on the likelihood of developing kidney dysfunction.

Inhibition of Streptococcus mutans growth and biofilm formation through protein acetylation.

Numerous cellular processes are regulated in response to the metabolic state of the cell, and one such regulatory mechanism involves lysine acetylation. Lysine acetylation has been proven to play an important role in the virulence of Streptococcus mutans, a major cariogenic bacterial species. S. mutans' glucosyltransferases (Gtfs) are responsible for synthesizing extracellular polysaccharides (EPS) and contributing to biofilm formation. One of the most common nonsteroidal anti-inflammatory drugs is acetylsalicylic acid (ASA), which can acetylate proteins through a nonenzymatic transacetylation reaction. Herein, we investigated the inhibitory effects of ASA on S. mutans. ASA treatment was observed to impede the growth of S. mutans, leading to a reduction in the production of water-insoluble EPS and the formation of biofilm. Moreover, ASA decreased the enzyme activity of Gtfs while increasing the protein acetylation level. The in vivo anticaries efficacy of ASA has further been proved using the rat caries model. In conclusion, ASA as an acetylation agent attenuated the cariogenic virulence of S. mutans, suggesting the potential value of protein acetylation on antimicrobial and anti-biofilm applications to S. mutans.

Initial intravenous immunoglobulin therapy without aspirin for acute Kawasaki disease: a retrospective cohort study with a Bayesian inference

ObjectiveTo clarify the necessity of acetylsalicylic acid (ASA) administration combined with intravenous immunoglobulin (IVIG) therapy in the treatment of acute Kawasaki disease.DesignRetrospective cohort study.SettingMulticentre.ParticipantsThis study included 735 patients with Kawasaki...

Acetylsalicylic acid treatment negatively influences the cancer-promoting ability of pancreatic stellate cells

Acetylsalicylic acid treatment negatively influences the cancer-promoting ability of pancreatic stellate cells

The comparison of the postoperative complications, mortality, and morbidity of the eversion technique and the classical technique in carotid endarterectomy

In the present study, the purpose was to compare the postoperative early and mid-term results of Eversion Carotid Endarterectomy (ECEA) and Classical Carotid Endarterectomy (CCEA) techniques used in the surgical treatment of carotid artery disease. A total of 269 patients who underwent carotid endarterectomy (105 ECEA and 164 CCEA) were included in the study. The 1st, 6th, and 12th-month follow-ups of 266 patients were performed because three patients died in the early postoperative period. All patients were started on acetylsalicylic acid, clopidogrel, and statin treatment in the postoperative period. When the postoperative results were evaluated, it was found that the cross-clamp and operation times of the surgeries performed with the ECEA technique were shorter than the CCEAat statistically significant levels (p=0.0002). Although there statistically significant differences were detected in terms of bleeding/drainage, need for reoperation because of bleeding, and restenosis, ECEA had more positive results than CCEA, and there were no statistically and proportionally significant differences between the two methods in terms of postoperative stroke and mortality. Considering the experience of the surgical team, the use of the ECEA technique has more positive results in terms of operation time and cross-clamp time compared to CCEA. We think that extending the follow-up periods of patients in the postoperative period and conducting multicenter studies with more patients would be more accurate in comparing these two methods.

The effects on clinical outcomes of administering medications together or separately in prolonged dual antiplatelet therapy after peripheral revascularisation.

In the current guidelines, dual antiplatelet therapy [acetylsalicylic acid (ASA) + clopidogrel] is recommended for at least three months after peripheral iliac stenting. In this study, we investigated the effect on clinical outcomes of adding ASA in different doses and at different times after peripheral revascularisation. Seventy-one patients were administered dual antiplatelet therapy after successful iliac stenting. Group 1, consisting of 40 patients, was given 75 mg of clopidogrel plus 75 mg of ASA in a single dose in the morning. In group 2, separate doses of 75 mg of clopidogrel (in the morning) and 81 mg of 1 × 1 ASA (in the evening) were started in 31 patients. The demographic data and bleeding rates of the patients after the procedure were recorded. The groups were found to be similar in terms of age, gender and accompanying co-morbid factors (p > 0.05). The patency rate was 100% in the first month in both groups, and it was above 90% at the sixth month. When one-year patency rates were compared, although the first group had higher rates (85.3%), no significant difference was found (p < 0.05). However, there were 10 (24.4%) bleeding events in group 1, and five (12.2%) of these were in the gastrointestinal system, resulting in reduced haemoglobin levels (p = 0.038). ASA doses of 75 mg or 81 mg did not affect one-year patency rates. However, higher bleeding rates were observed in the group that received both clopidogrel and ASA treatment simultaneously (in the morning) despite the lower dose of ASA.

Acetylsalicylic acid reduces cigarette smoke withdrawal-induced anxiety in rats via modulating the expression of NFĸB, GLT-1, and xCT.

Background: Chronic exposure to cigarette smoke produces neuroinflammation and long-term changes in neurotransmitter systems, especially glutamatergic systems. Objective: We examined the effects of cigarette smoke on astroglial glutamate transporters as well as NF-κB expression in mesocorticolimbic brain regions, prefrontal cortex (PFC) and nucleus accumbens (NAc). The behavioral consequences of cigarette smoke exposure were assessed using open field (OF) and light/dark (LD) tests to assess withdrawal-induced anxiety-like behavior. Methods: Sprague-Dawley rats were randomly assigned to five experimental groups: a control group exposed only to standard room air, a cigarette smoke exposed group treated with saline vehicle, two cigarette smoke exposed groups treated with acetylsalicylic acid (ASA) (15mg/kg and 30mg/kg, respectively), and a group treated only with ASA (30mg/kg). Cigarette smoke exposure was performed for 2h/day, 5days/week, for 31days. Behavioral tests were conducted weekly, 24h after cigarette smoke exposure, during acute withdrawal. At the end of week 4, rats were given either saline or ASA 45min before cigarette exposure for 11days. Results: Cigarette smoke increased withdrawal-induced anxiety, and 30mg/kg ASA attenuated this effect. Cigarette smoke exposure increased the relative mRNA and protein expression of nuclear factor ĸB (NFĸB) in PFC and NAc, and ASA treatment reversed this effect. Also, cigarette smoke decreased the relative mRNA and protein expression of glutamate transporter1 (GLT-1) and the cystine-glutamate transporter (xCT) in the PFC and the NAc, while ASA treatment normalized their expression. Conclusion: Cigarette smoke caused neuroinflammation, alterations in glutamate transporter expression, and increased anxiety-like behavior, and these effects were attenuated by acetylsalicylic acid treatment.

Низкая приверженность терапии и пути ее преодоления на примере антиагрегантной терапии

The article is focused on the issues of poor patient adherence to medication treatments, including antiplatelet drugs, its reasons, and solutions for overcoming compliance barriers. As of today, treatment adherence remains low leading to a higher risk of cardiovascular complications. Poor adherence to acetylsalicylic acid (ASA) treatment is mainly linked to a relatively frequent development of gastrointestinal side effects. The solutions for overcoming this problem include the use of lowest effective doses and the development of different acetylsalicylic acid (ASA) formulations: enteric coated and buffered. The efficacy and safety of these formulations are compared in the article. Buffered formulation (e.g. ASA + magnesium hydroxide) is similar to plain ASA as regards its antiplatelet activity and the prevalence of "aspirin- resistance", while its intake is associated with a lower risk of enteropathy and gastropathy as compared to plain and even enteric coated ASA. This is particularly important for patients with obesity and diabetes mellitus, as these conditions are associated with an affected rate of absorption from the small intestine. Based on the study findings a conclusion is made that buffered ASA should be the preferred formulation for use. The literature review is illustrated by a clinical case. KEYWORDS: chronic ischemic heart diseases, secondary prevention, adherence to therapy, acetylsalicylic acid, antiaggregant therapy, acetylsalicylic acid buffered and enteric coated formulations, aspirin-resistance. FOR CITATION: Ageev F.T., Smirnova M.D., Fofanova T.V. Poor patient adherence to medication treatments and solutions for overcoming compliance barriers as illustrated by antiplatelet therapy. Russian Medical Inquiry. 2023;7(1):56–61 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-1-56-61.

Acetylsalicylic Acid and Mood Disorders: A Systematic Review.

The effects of acetylsalicylic acid (ASA) on mood disorders (MD) and on inflammatory parameters in preclinical and clinical studies have not yet been comprehensively evaluated. The aim of this study was to systematically summarize the available knowledge on this topic according to PRISMA guidelines. Data from preclinical and clinical studies were analyzed, considering the safety and efficacy of ASA in the treatment of MD and the correlation of inflammatory parameters with the effect of ASA treatment. Twenty-one studies were included. Both preclinical and clinical studies found evidence indicating the safety and efficacy of low-dose ASA in the treatment of all types of affective episodes in MD. Observational studies have indicated a reduced risk of all types of affective episodes in chronic low-dose ASA users (HR 0.92, 95% CI: 0.88, 0.95, p &lt; 0.0001). An association between ASA response and inflammatory parameters was found in preclinical studies, but this was not confirmed in clinical trials. Further long-term clinical trials evaluating the safety and efficacy of ASA in recurrent MD, as well as assessing the linkage of ASA treatment with inflammatory phenotype and cytokines, are required. There is also a need for preclinical studies to understand the exact mechanism of action of ASA in MD.

Acetylsalicylic-acid (ASA) regulation of osteo/odontogenic differentiation and proliferation of human dental pulp stem cells (DPSCs) in vitro

ObjectiveThe study aimed to investigate acetylsalicylic acid (ASA) effects on osteo/odontogenic differentiation and proliferation of dental pulp stem cells (DPSCs) in vitro and the potential involvement of adenosine monophosphate-activated protein kinase (AMPK) pathway in these processes. DesignDPSCs were isolated from third molars pulp tissues of five patients and grown in osteogenic medium alone or supplemented with ASA. Expression of DPSCs markers was tested by flow-cytometry. Cytotoxicity of ASA at concentrations of 10, 50 and 100 µg/ml was tested by MTT and NR assays. Osteo/odontogenic differentiation was analyzed via alizarin red staining and ALP activity. Quantitative PCR (qPCR) was used for osteo/odontogenic markers’ (DSPP, BMP2, BMP4, BSP, OCN and RUNX2) and c-Myc expression analysis. AMPK inhibition of ASA-induced osteo/odontogenesis was tested by qPCR of selected markers (DSPP, OCN and RUNX2). ResultsCytotoxicity assays showed that only the highest ASA dose decreased cell viability (89.1 %). The smallest concentration of ASA applied on DPSCs resulted in a remarkable enhancement of osteo/odontogenic differentiation, as judged by increased mineralized nodules’ formation, ALP activity and gene expression of analyzed markers (increase between 2 and 30 folds), compared to untreated cells. ASA also increased DPSCs proliferation. Interestingly, AMPK inhibition per se upregulated DSPP, OCN and RUNX2; the gene upregulation was higher when ASA treatment was also included. c-Myc expression level decreased in cultures treated with ASA, indicating undergoing differentiation processes. ConclusionsLow concentrations of ASA (corresponding to the standard use in cardiovascular patients), were shown to stimulate osteo/odontogenic differentiation of dental pulp stem cells.

Transcriptome analysis reveals mechanisms of acetylsalicylic acid-mediated fruit quality maintenance in fresh-cut kiwifruit

Postharvest ripening and processing of fresh-cut (FC) kiwifruit brings quality deterioration and spoilage, including substantial changes in fruit color, texture and flavor. Hence, a series of preservation techniques have emerged to reduce postharvest loss and maintain FC kiwifruit quality. In this study, we evaluated the efficacy of acetylsalicylic acid (ASA), a derivative of plant endogenous hormone salicylic acid, in preserving the quality and delaying the ripening process of FC kiwifruit. Compared to the control fruit, ASA treatment maintained a better fruit appearance and higher fruit firmness, as well as reducing mass loss, total soluble solids and ethylene production. Based on the RNA-seq data and weighted gene co-expression network analysis (WGCNA), eight biosynthetic genes were identified as involved in fruit quality change, which participates in cell wall metabolism, starch degradation/sugar accumulation and ethylene biosynthesis. Moreover, the analysis showed that four transcription factors were significantly induced by exogenous ASA treatment. Dual-luciferase assays proved that ASA-responsive transcription factors regulated fruit quality-related genes, resulting in delaying ripening process and extending the shelf-life of FC kiwifruit. This study showed that ASA effectively delayed the ripening process, and AcWRKY7/AcDOF21/AcC2H2–151/AcbHLH123 are associated with the ASA-mediated fruit quality maintenance.

Sensörimotor demiyelizan polinöropati ile birlikte primer Raynaud Fenomeni: bir olgu sunumu

Raynaud's phenomenon (RP) is characterized by color changes and episodic vasospasm in the distal parts of the body. Raynaud's phenomenon associated with sensorimotor demyelinating polyneuropathy has been rarely reported in the literature. Here, we aimed to present a 36-year-old male patient who was admitted to our clinic with complaints of discoloration, numbness, and tingling in the upper and lower extremities. A mixed type of sensorimotor demyelinating polyneuropathy was detected in nerve conduction studies of the patient. A significant improvement was observed within 2 months after pregabalin, acetylsalicylic acid, and nifedipine treatment.

Study the Association of Nucleotide Polymorphisms in Platelet Receptor and Cytochrome P450 Genes with the Development of Resistance to Antiplatelet Drugs in Patients with Coronary Artery Disease

Aim. To study the association of nucleotide polymorphisms in platelet receptor and cytochrome P450 genes with the development of resistance to antiplatelet drugs in CHD patients.Material and Methods. The study included 243 patients diagnosed with CHD after coronary artery bypass surgery (CABG), including 140 patients in the acetylsalicylic acid (ASA) treatment group and 103 patients in the dual antiplatelet therapy (DAT) group. All patients were tested for platelet aggregation using an optical aggregometer with inducers: 5 mM ADP and 1 mM arachidonic acid (AA). DNA samples were analyzed by allele-specific PCR for the presence of polymorphisms rs2046934, rs1126643, rs5918, rs6065, rs4244285 in the platelet receptor and cytochrome P450 genes.Results. No statistically significant differences were found during comparison of the prevalence of the studied polymorphisms in the platelet receptor and cytochrome P450 genes between the groups of aspirin-sensitive and aspirin-resistant patients, as well as between the groups of clopidogrelsensitive and clopidogrel-resistant patients. No association between carriage of the minor and major alleles of the polymorphisms studied and the development of antiplatelet drug resistance was found. In the group of patients on ASA therapy, carriers of the C allele of the T1565C (rs5918) ITGB3 polymorphism had a higher rate of AA-induced platelet aggregation compared to carriers of the T allele (18,49±25,92 vs 10,43±17,34, р=0,004).Conclusion. Polymorphisms of P2RY12 (rs2046934), ITGA2 (rs1126643), ITGB3 (rs5918), GP1BA (rs6065), CYP2C19*2 (rs4244285) genes are not associated with antiplatelet drug resistance in both patients on ASC therapy and on DAT. The presence of minor alleles of the rs2046934, rs1126643, rs6065, rs4244285 polymorphisms are not associated with increased platelet aggregation activity before CABG.However, in the group of patients on ASA therapy C-allele carriers of the rs5918 polymorphism of the ITGB3 gene had a higher rate of AA-induced platelet aggregation compared to T-allele carriers.

Concomitant acute lower extremity arterial and deep vein thrombosis developing in a patient under anticoagulant therapy after COVID 19 infection.

The hypercoagulable state continues after the Coronavirus 2019 (Covid 19) infection and prophylactic anticoagulants are recommended in this period. However, arterial and venous thromboembolic events can be observed during the convalescence period after the Covid 19. Here, we present the case of acute lower extremity arterial and venous thromboembolism developed in the post-Covid 19 period in a 77-years-old patient, under therapeutic doses of anticoagulant therapy (enoxparin 1mg/kg of weight every 12 hours). The patient, who had no previous history of arterial or venous thrombosis, was taken to emergency surgery with the diagnosis of ALI (acute limb ischemia) due to acute arterial thrombosis. An arterial thrombectomy was performed with the help of a 4F Fogarty catheter inserted from the left femoral artery under local anesthesia. All distal pulses of the patient were palpable in the postoperative period. After the platelet count became &gt;100,000 mm3, 100 mg of acetylsalicylic acid daily was added to the therapeutic dose of enoxaparin sodium treatment. The patient was discharged, uneventfully, except for a minimal diameter increase secondary to deep venous thrombosis (DVT) on the fifth postoperative day, with a combination of enoxaparin and acetylsalicylic acid treatment. Endothelial injury, chronic immuno-thrombogenicity, and increased platelet aggregation in the post-Covid 19 recovery period can cause major thrombotic events, even weeks after the recovery. Anticoagulant therapy is recommended for thromboprophylaxis when the following statuses exist: ≥65 years, critical illness, cancer, prior VTE, thrombophilia, severe immobility, and elevated Ddimer. Combination treatment with long-term antiaggregant therapy may be prudent in thromboembolic events developed under anticoagulant therapy.

Management of Multisystem Inflammatory Syndrome in Children with Combined Use of Corticosteroids and Intravenous Immunoglobulin—Report from Bursa, Turkey

Abstract Objective In this article, we aimed to evaluate the clinical, laboratory, and radiological findings and outcomes of patients treated with corticosteroids and intravenous immunoglobulin (IVIG) with the multisystem inflammatory syndrome in children (MIS-C) in two centers in Bursa, Turkey. Methods We retrospectively collected the clinical characteristics, laboratory results, and treatment outcomes of MIS-C cases treated in two centers from April 2020 to February 2021. Patients were compared both according to their clinical categorization and the place they were hospitalized in, as well as with studies published in the literature. Results Fifty-six patients were included. Thirty-six (64.3%) were male with a mean age of 67.95 ± 50.87 months. Thirty patients (53.5%) were categorized as Kawasaki-like disease, 17 (30.3%) sepsis-like disease, and 9 (16%) were toxic shock syndrome (TSS). Admission symptoms were fever (100%), rash (71.4%), myalgia (69.6%), and abdominal pain (62.5%). Seventeen (30.3%) patients were hospitalized in pediatric intensive care unit. Elevated C-reactive protein levels, procalcitonin, erythrocyte sedimentation rate, D-dimer, and troponin were found in 100, 77, 84, 84, and 23.2% of the patients, respectively. Of all, 55 (98.2%) received IVIG, 54 (96.4%) corticosteroids, 56 (100%) antibiotic therapy, 22 (40%) albumin infusion, and 13 (23.2%) inotropic support. Fifty patients (89.3%) received low-molecular-weight heparin: enoxaparin, followed by acetylsalicylic acid treatment. Only one patient who was resistant to both IVIG and steroid treatment received Anakinra. One patient (1.7%) with TSS died within 1 hour of hospitalization. Conclusion Combined use of IVIG and corticosteroids is an effective way of treatment in MIS-C patients resulting in low mortality.

A dual mechanism fully blocks ethanol relapse: Role of vagal innervation.

Previous studies showed that vagotomy markedly inhibits alcohol self-administration. Present studies hypothesised that vagotomy significantly adds to the inhibition of alcohol relapse induced by drugs that reduce the alcohol-induced hyperglutamatergic state (e.g., N-acetylcysteine + acetylsalicylic acid). The alcohol relapse paradigm tested gauges the elevated alcohol intake observed in animals that had consumed ethanol chronically, were subjected to a prolonged alcohol deprivation and are subsequently allowed ethanol re-access. Ethanol-drinker rats (UChB) were exposed to 10% and 20% ethanol and water concurrently for 4months, were alcohol deprived for 14 days and were thereafter allowed re-access to the ethanol solutions. An initial binge-like drinking episode is observed upon ethanol re-access, followed by a protracted elevated ethanol intake that exceeds the predeprivation intake baseline. Prior to ethanol re-access, animals were (i) administered N-acetylcysteine (40 mg/kg/day) + acetylsalicylic acid (15 mg/kg/day), (ii) were bilaterally vagotomised, (iii) were exposed to both treatments or (iv) received no treatments. The initial binge-like relapse intake and a protracted elevated ethanol intake observed after repeated ethanol deprivations/re-access cycles were inhibited by 50%-70% by the administration of N-acetylcysteine + acetylsalicylic acid and by 40%-70% by vagotomy, while the combined vagotomy plus N-acetylcysteine + acetylsalicylic acid treatment inhibited both the initial binge-like intake and the protracted ethanol intake by >95% (p < 0.001), disclosing a dual mechanism of ethanol relapse and subsequent inhibition beyond that induced by either treatment alone. Future exploration into the mechanism by which vagal activity contributes to ethanol relapse may have translational promise.

Ацетилсалициловая кислота в профилактике преэклампсии и ее осложнений. Современные представления о группах риска

This paper reviews current published data on the use of acetylsalicylic acid (ASA) for preventing preeclampsia and its complications and techniques to determine risk groups for im-plementing this preventive treatment. In addition, the authors summarize data on the history of ASA advent and introduction into medical practice (particularly obstetrics) and presumed mech-anisms of its action as first-line therapy to prevent preeclampsia. Recent review papers and guidelines addressing optimal ASA dose, treatment duration, and dosing during pregnancy in Russia and worldwide are discussed. Methods that have been studied as preventive ones for preeclampsia are briefly discussed. It was demonstrated that anamnestic determination of risk groups of early preeclampsia is not always enough. Expanded combined first-trimester screening is a perspective diagnostic tool. Success in determining high-risk groups and optimal prevention of preeclampsia may significantly affect population health by reducing maternal and perinatal mortality and long-term risk of cardiovascular events both in the mother and child. KEYWORDS: preeclampsia, acetylsalicylic acid, screening, placental disorders, trophoblast, fetal growth restriction, prevention of preeclampsia, uterine artery pulsatility index, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF). FOR CITATION: Kuznetsov P.A., Dzhokhadze L.S., Shamugiya V.V., Kravtsova O.M. Acetylsalicylic acid to prevent preeclampsia and its complications. State-of-the-art of risk groups. Russian Journal of Woman and Child Health. 2022;5(1):28–34 (in Russ.). DOI: 10.32364/2618-8430-2022-5-1-28-34.

The effectiveness and safety of ibuprofen and acetylsalicylic acid in acute rheumatic fever.

Acetylsalicylic acid (ASA) is a non-steroidal anti-inflammatory drug used in the treatment of acute rheumatic fever (ARF) and it can cause serious adverse effects. This study aimed to evaluate the clinical efficacy and side effects of ibuprofen in the treatment of ARF compared to the classic treatment, ASA. Children who were hospitalized for the treatment of ARF with isolated arthritis and mild carditis between October 2015 and October 2018 and who received non-steroidal anti-inflammatory therapy were evaluated in the study. We compared the demographic data, clinical findings, efficacy, and side effects of the treatments of the children, who were divided into ASA and ibuprofen groups. Of the 38 patients included in the study, 21 were treated with ASA (ASA group), and 17 were given ibuprofen (IBU group). There was no difference between the groups regarding the length of hospital stay, total treatment time, time to resolution of clinical symptoms, and normalization of acute-phase reactants. Liver enzymes increased during treatment in 13 patients (62%) in the ASA group and three patients (18%) in the IBU group (P = 0.009). In the ASA group, 69% of patients with increased liver enzymes were under 11 years of age during treatment. Clinical side effects were observed in three patients in the ASA group while none were observed in the IBU group. The results of this study suggest that ibuprofen can be a safe alternative in the treatment of ARF, especially in young children. Although ibuprofen can be a safe and effective alternative to ASA, studies including larger series are needed on this subject.

Effect of the Renin-Angiotensin-Aldosterone System Reactivity on Endothelial Function and Modulative Role of Valsartan in Male Subjects with Essential Hypertension.

Background: The aim of the study was to evaluate the relationship between renin-angiotensin-aldosterone (RAA) system activity and reactivity, and the endothelial function profile in normotensive subjects (N), and in essential hypertensives (H), followed by analysis of the modulatory role of an angiotensin receptor blocker (ARB): valsartan, administered in the management of hypertension. Methods: A total of 101 male subjects were enrolled to the study: 31H and 70N. The nitric-oxide (NO) bioavailability (l-Arginine, asymmetric dimethylarginine (ADMA)), symmetric dimethylarginine (SDMA), endothelial vasodilative function (flow mediated dilation (FMD)), oxidative-stress markers (malonyldialdehyde (MDA), thiol index (GSH/GSSG), nitrotyrozine (N-Tyr)), and pro-inflammatory/angiogenic parameters (sICAM-1, sVCAM-1, PAI-1, sE-selectin, PAI-1, thromboxane -B2) were assessed at baseline, then after intravenous -l-arginine administration, which was repeated after the 4-day acetylsalicylic acid (ASA) administration (75 mg/24 h). In hypertensives, this whole protocol was repeated following 2 weeks of valsartan therapy. Results: No effect of valsartan and ASA on the flow-mediated vasodilation (FMD) and the NO bioavailability in hypertensives was observed. Administration of valsartan increased plasma renin activity (PRA), but without a decrease in the aldosterone levels. ASA treatment minimized the pre-existing differences between the groups, and increased the PRA in the N-subgroup with the highest ARR values. The blood concentrations of proinflammatory sICAM-1, sE-selectin, sVCAM-1, and PAI-1 were higher, whereas the anti-inflammatory 6-keto-PGF1 alpha level was lower in hypertensive subjects. The levels of angiogenic VEGF did not differ between groups. Conclusions: Our study does not confirm the modulative effect of valsartan on endothelial function. Normotensive men showed an increase in FMD after l-arginine administration, possibly indicating baseline impairment of the NO synthesis.

Acetylsalicylic acid for metal stent in malignant distal common bile duct obstruction: A randomized controlled trial

BackgroundEndoscopic biliary drainage is the treatment of choice for patients with malignant distal common bile duct obstruction. Self-expandable metal stents have clinical advantages including an increased duration of patency that may be prolonged by acetylsalicylic acid (ASA) use. The aim of this study was to investigate whether ASA had a positive effect on the patency of self-expandable metal stents compared with placebo. MethodsThis prospective, multicenter, double-blinded, and randomized placebo-controlled trial was conducted from October 2017 to May 2020 in Korea. Patients who underwent palliative endoscopic biliary drainage with self-expandable metal stents for malignant distal bile duct obstruction were enrolled, and allocated to ASA treatment or placebo. The study outcomes were the rate of stent dysfunction at 6 months, duration of stent patency, risk factors for stent dysfunction, and any adverse events. ResultsInterim analysis included 24 and 28 patients in the ASA and placebo groups, respectively. There was no significant difference between the ASA and placebo groups in stent dysfunction (25.0% vs. 20.7%, P = 0.761) or the duration of stent patency (150.97 ± 10.55 vs. 158.07 ± 8.70 days, P = 0.497). Six patients experienced suspected ASA-related adverse events, and there was one lethal case. ConclusionsASA did not prolong stent patency. This study was terminated early because of the possibility of serious adverse events related to ASA treatment of these patients receiving palliative care.