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This study was carried out to evaluate the effects of supplementation with different levels of copper (Cu) and zinc (Zn), using two mineral sources (sulphate and hydroxy forms), on the bone characteristics, skin strength/elasticity, and haematological parameters of broilers. A total of 1792 1‐day‐old male Cobb‐500 broiler chickens were randomly distributed among eight dietary treatments, using Cu sulphate (CSM) or hydroxychloride (CHC), and Zn sulphate (ZSM) or hydroxychloride (ZHC). The dietary treatments were as follows: (1) low‐CSM/high‐ZSM, (2) high‐CSM/high‐ZSM, (3) low‐CHC/low‐ZHC, (4) low‐CHC/medium‐ZHC, (5) low‐CHC/high‐ZHC, (6) high‐CHC/low‐ZHC, (7) high‐CHC/medium‐ZHC, and (8) high‐CHC/high‐ZHC. On Day 42, blood samples were collected from one bird/pen to analyze the haematological parameters. Finally, two birds/pen were slaughtered, and the tibia and femur were collected to analyze the quality of bone and skin. The means were subjected to ANOVA and, when significant, compared by Tukey's test (p < 0.05) or Dunnett's (p < 0.05) test. The haematological parameters were not influenced by mineral supplementation. However, the inclusion of low ZHC enhanced the skin strength compared to high ZHC (p = 0.046). Furthermore, the bone mineral density of the tibia proximal epiphysis, tibia ash and tibia mineral content were positively improved with supplementation of low‐CHC/medium‐ZHC compared to high‐CHC/medium‐ZHC. This study demonstrated that hydroxy compounds are potential alternatives for replacing sulphate supplements in broiler diets. Moreover, among the Cu and Zn levels, the low CHC (15 mg/kg) and medium ZHC (100 mg/kg) improved bone development and skin integrity, suggesting that the combination of Cu and Zn can be a nutritional strategy to prevent the incidence of leg disorders in broilers. [ABSTRACT FROM AUTHOR]

Background & Aims: Liver stiffness measured with 2‐dimensional shear wave elastography by Supersonic Imagine (2DSWE‐SSI) is well‐established for fibrosis diagnostics, but non‐conclusive for portal hypertension. Methods: We performed an individual patient data meta‐analysis of 2DSWE‐SSI to identify clinically significant portal hypertension (CSPH), severe portal hypertension and large varices in cirrhosis patients, using hepatic venous pressure gradient and upper endoscopy as reference. We used meta‐analytical integration of diagnostic accuracies with optimized rule‐out (sensitivity‐90%) and rule‐in (specificity‐90%) cut‐offs. Results: Five studies from seven centres shared data on 519 patients. After exclusion, we included 328 patients. Eighty‐nine (27%) were compensated and 286 (87%) had CSPH. 2DSWE‐SSI < 14 kPa ruled out CSPH with a summary AUROC (sROC), sensitivity and specificity of 0.88, 91% and 37%, and correctly classified 85% of patients, with minimal between‐study heterogeneity. The false negative rate was 60%, of which decompensated patients accounted for 78%. 2DSWE‐SSI ≥ 32 kPa ruled in CSPH with sROC, sensitivity, specificity and correct classifications of 0.83, 47%, 89% and 55%. In a subgroup analysis, the 14 kPa cut‐off showed consistent sensitivity and higher specificity for patients with compensated cirrhosis, without ascites, viral aetiology or BMI < 25 kg/m2. 2DSWE‐SSI ruled out severe portal hypertension and large varices with fewer correctly classified and lower sROC, and with minimal benefit for ruling in. Conclusion: Liver stiffness using 2‐dimensional shear wave elastography below 14 kPa may be used to rule out clinically significant portal hypertension in cirrhosis patients, but this would need validation in populations of compensated liver disease. 2DSWE‐SSI cannot predict varices needing treatment. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Association between the microarray-based CYP2C19 genotyping assay and the platelet function test in cardiovascular patients receiving clopidogrel," that was published in a previous issue of the journal is presented.

Introduction: The Hematoflow (Beckman Coulter, USA) is a new automated hematology analyzer, which provides a 16-part white blood cell count (WBC) differential. Methods: We evaluated the differential WBC count performance of the Hematoflow. 101 blood samples from patients were selected for comparison analysis. Results: The methodological comparison of the WBC differential parameters of neutrophils, lymphocytes, monocytes and eosinophils showed good correlations among 4 different analyses. More than 1% of blast cells were counted in 30 of 101 samples. A good correlation for blast cell counts obtained by Hematoflow was found with the reference manual method (r=0.9637, P 0.0001). For blast B, Hematoflow shows good correlation with reference method results but did not identify blast T. Conclusions: These results demonstrate that the Hematoflow has a comparable performance with the Sysmex XE-2100 and indicate that B cell lineage ALL can be identified by the use of the Hematoflow in an initial evaluation of acute leukemia. [ABSTRACT FROM AUTHOR]

Background/Aim The aim of this study was to assess the patterns of lamivudine ( LAM)-resistant mutations and the influence on biochemical and virological responses to adefovir ( ADV) add-on LAM combination therapy in patients with LAM-resistant chronic hepatitis B ( CHB). Methods Seventy-eight CHB patients with confirmed genotypic resistance to LAM, who initiated ADV add-on LAM combination treatment, were enrolled at our institution between April 2007 and April 2009. Results The baseline tyrosine-methionine-aspartate-aspartate ( YMDD) mutation patterns were as follows: rtM204I 45 (57.7%); and rtM204V + rtM204I/V 33 (42.3%). The decrease in the mean ± standard deviation ( SD) serum log10 HBV- DNA level did not differ between the patients carrying the rtM204I vs. rtM204 IV +rtM204I/V mutations at 3, 6 and 12 months after the initiation of ADV add-on LAM combination treatment. The proportion of patients who achieved ALT normalization (<40 IU/L) 12 months after the initiation of ADV add-on LAM combination treatment were significantly higher in patients with a rtM204I mutation than rtM204V+ rtM204I/V mutations (39 [86.7%] vs. 22 [66.7%], P = 0.05). The proportion of patients in whom the log10 HBV- DNA decreased <2 log10 copies/ml, 6 months after the initiation of ADV add-on LAM combination treatment (non-responders), was significantly higher in patients with a rtM204V + rtM204I/V mutations than rtM204I mutation (7 [21.2%] vs. 2 [4.4%], P = 0.032). Conclusion Biochemical response at 12 months from baseline was better in patients with a rtM204I mutation than rtM204V+ rtM204I/V mutations. In addition, early treatment failure was more common in patients with rtM204V+ rtM204I/V mutations than a rtM204I mutation. [ABSTRACT FROM AUTHOR]

This article briefly reviews the history of white pine blister rust, attributed to Cronartium ribicola, and addresses current research and management issues in South Korea, Japan and other regions of eastern Asia (China, Russia and Himalaya). For each region, the distribution, damage, aecial hosts, telial hosts and management of C. ribicola and other blister rust fungi on native and introduced white pines are summarized. In addition, blister rust behaviours in eastern Asia and North America are compared; and the potential evolutionary and management implications are discussed. [ABSTRACT FROM AUTHOR]

Aspirin reduces the prevalence of nonfatal myocardial infarction, stroke, and death by 25.0% in high risk group of patients with cardiovascular disease. Previous studies have estimated that about 5.5–56.8% of the population are aspirin resistant. The mechanisms of aspirin resistance (AR) have not been fully understood. We compared the detection methods for AR using traditional platelet aggregometry and VerifyNow system. One hundred and seventy-two coronary artery disease patients who had taken aspirin only or combinations with aspirin and clopidogrel for over 7 days were included. Of the 55 patients with aspirin only, aggregometer detected six AR (10.9%) and VerifyNow identified 10 AR (18.2%) cases. Among 117 patients with combined therapy, none (0.0%) and 10 (8.5%) of AR were detected by aggregometer and VerifyNow, respectively. There were six (3.4%) patients of AR defined by both methods and they all received aspirin monotherapy. Although the correlation between the aggregometry and VerifyNow was low, with defined criteria both methods gave 91.9% agreement to find AR. VerifyNow showed a higher sensitivity to detect AR. Further studies are required to biologically define AR and to alter therapy based on platelet function tests. [ABSTRACT FROM AUTHOR]

Six pine species or hybrids were tested for susceptibility to pitch canker caused by Fusarium  circinatum. Pinus  densiflora, Pinus  thunbergii, Pinus  x rigitaeda ( Pinus  rigida × Pinus  taeda), P. rigida × P. x rigitaeda, Pinus  echinata and Pinus  virginiana were inoculated with three spore loads (50, 500 and 5000 per tree) of F.  circinatum. External symptoms, lesion length, and the frequency of reisolation of the fungus were investigated. External symptoms were greatest in P.  echinata, followed by P.  virginiana, however, P.  densiflora was not susceptible to F. circinatum. Based on mean lesion lengths, the six pine species or hybrids differed significantly (p < 0.01) in susceptibility to pitch canker. Pinus  echinata sustained the longest lesions, whereas P.  densiflora sustained the shortest lesions. The effect of inoculum density was not significant among three spore treatments within species (p = 0.17), although lesion length was slightly greater at higher spore loads over all pine species. The fungus was reisolated from inoculated stems of all pine species tested, even on trees showing little or no damage from the disease. Additional studies are needed to further explore the basis for resistance to pitch canker. [ABSTRACT FROM AUTHOR]

Stromatolite morphology is usually controlled by a number of biological and environmental factors. In the south-eastern part of the Korean Peninsula, three stromatolite units of the Cretaceous Sinyangdong Formation have been studied with regard to the effect of diagenesis on their morphology. Here, it is proposed that subaerial exposure and meteoric diagenesis are the most significant factors in shaping the stromatolites of the Cretaceous Sinyangdong Formation. Most previous palaeontological and sedimentological studies on stromatolites have concentrated on the environmental and biogenic controls on stromatolite morphology. These include extrinsic factors such as sedimentation rates or current velocities. The main controlling factor on the morphology of the stromatolites in the Sinyangdong Formation is apparently transient subaerial exposure and related meteoric diagenesis. Textural examination of stromatolite samples from three stratigraphic horizons shows a characteristic repetitive pattern of cycles with gradual transition from fibrous calcite to micrite layers, reflecting changes in the hydrological cycle of the lake in which the stromatolites grew. Stromatolite growth was terminated by corroded surfaces indicative of subaerial exposure related to a fall in lake level. The growth pattern of the stromatolites was mostly determined by the morphology of the corroded substrates during subaerial exposure. Furthermore, the internal stromatolite structure was strongly modified by the process of leaching. As a result, growth forms mostly changed from stratiform to columnar mesostructure. This study strongly implies that diagenesis could make a very significant influence on the morphogenesis of lacustrine stromatolites in the geological past. [ABSTRACT FROM AUTHOR]

Summary In a few plant pathosystems, defeated major genes have been shown to contribute to partial resistance to disease. This hypothesis has never been tested before in a forest tree, but pathogenic variation associated with recent hybridization in poplar rust in the Pacific northwest provided an opportunity. An F2 progeny of 256 poplar clones in the field near Corvallis, Oregon, USA, has been monitored for rust severity and infection type since the advent of the new hybrid rust, Melampsora × columbiana , in the mid-1990s. All 256 clones displayed a susceptible infection type in 1997 and again in 2000, and yet variation in uredinial density (i.e. partial resistance) was still observed. To determine which clones possessed a defeated resistance gene, a greenhouse inoculation was performed with an isolate of M. medusae , one of the parents of M . × columbiana . Clones that would have been resistant to M. medusae , prior to the advent of M . × columbiana , were thus identified. The inoculation resulted in a 1 : 1 segregation (χ 2 =0.772; p=0.38) for resistance, indicating the presence of a major gene. However, the F2 clones possessing the defeated resistance gene displayed the same level of partial resistance in the field in both 1997 and 2000 as their full siblings lacking the gene. [ABSTRACT FROM AUTHOR]

Abstract Background. Epidemiological studies have suggested a link between chronic Helicobacter pylori infection and ischemic heart disease but the underlying mechanism remains elusive. We hypothesized that H. pylori-associated chronic gastritis causes impairment of absorption of vitamin cofactors that are essential in the metabolism of homocysteine and results in hyperhomocysteinemia. Materials and Methods. Forty-nine dyspeptic patients were studied. H. pylori infection was defined by rapid urease test and histology. Fasting serum homocysteine level, which was measured by a validated commercial fluorescence polarization immunoassay, was correlated with H. pylori infection statuses and gastric histology. H. pylori-infected patients were followed up for 24 weeks post eradication for changes in serum homocysteine concentration. Results. Univariate analyses showed that serum homocysteine level correlated with increasing age (p < .001), male sex (p = .003) and smoking habit (p = .025). There was no significant difference in serum homocysteine levels between H. pylori infected and uninfected subjects (median 10.5 vs. 10.2 µmol/l). After successful eradication of the bacterium, there was no significant reduction in homocysteine level. Moreover, there was no correlation between homocysteine level and gastric histology including H. pylori density, activity and inflammation scores, presence of atrophy or intestinal metaplasia. Conclusions. The postulated link between H. pylori infection and ischemic heart disease, if it actually exists, is unlikely to be mediated through hyper-homocysteinemia. [ABSTRACT FROM AUTHOR]

A descriptive-correlational design was used to examine the relationships between dyspnoea, physical activity, and fatigue in patients with chronic obstructive pulmonary disease (COPD). Lazarus and Folkman's theory of stress, appraisal, and coping provided a framework to guide the study. Dyspnoea was measured by a vertical visual analogue scale, fatigue by the Fatigue subscale of the Profile of Mood States, and physical activity by the six-minute walk (6MW) test and an open-ended question. A convenience sample of seven male and 15 female patients with COPD provided data for analysis. The sample was characterized by relatively high forced expiratory volume in one second (FEV1) indicating mild lung impairment and high mean levels of fatigue and dyspnoea. No significant gender difference was found in the ratings of dyspnoea and fatigue and the 6MW distance. Dyspnoea, physical activities, and fatigue were all significantly inter-related (P < 0.001). Results indicated that the higher the dyspnoea scores, the shorter the 6MW distance walked, and the higher the fatigue scores. Limitations and suggestions for nursing practice and future research are presented. [ABSTRACT FROM AUTHOR]

A simple mechanical method for the rapid isolation of chloroplasts with high rates of photosynthesis from young leaves of oat (Avena sativa L.) was described. The photosynthetic activity of these chloroplasts was stable for at least 2 h with rates of CO2-dependent O2 evolution of 30-40 μmol g-1 Chl s-1. The photosynthetic properties of these chloroplasts were similar to those reported for spinach and pea chloroplasts isolated by mechanical disruption. The pH optimum for photosynthetic O2 evolution was pH 7.6. The induction time was 0.5 2 min. Maximal rates of photosynthetic O2 evolution in these chloroplast preparations were obtained in the absence of both divalent cations and EDTA. Addition of divalent cations strongly inhibited photosynthesis which could be partially restored by the subsequent addition of EDTA. But when these cations were not present in the assay medium the addition of EDTA greater than 1 mol m-1 decreased photosynthetic activity. The optimal orthophosphate concentration required for photosynthesis in these chloroplast preparations was 0.2 0.3 mol m-3. In contrast, the addition of pyrophosphate either in the light or dark inhibited photosynthesis. In a comparative study, chloroplasts were also isolated from oat and wheat (Triticum aestivum L., cultivar Hybrid C306) protoplasts. These chloroplast preparations were found to have properties similar to those determined for oat chloroplasts isolated by the mechanical method reported above. [ABSTRACT FROM AUTHOR]

Plant life processes are related in a complex way to the balance between the water demand of the atmosphere and the availability of water to the plant root. An exploration of the dynamic status of water in the plant is very important. As an approach to an integrated analysis of the dynamic system of water movement through the soil-plant-atmosphere continuum, a simulation model of the transpiration process is presented. Van den Honert suggested the use of Ohm's law describing water flow into, through, and out of plants. In the present study, this hypothesis has been expanded to include an analogous storage factor to deal with the dynamic flow of water in the plant. A set of differential equations and transfer functions is expressed in terms of water suction variables. The dynamic description of the water status in the plant is completed by introducing the system gain, which is a function of both the transpiration rate and the soil-water condition. The dynamic system gain is realized by a method similar to Corbin's method of a computer-controlled adaptive control system. The entire system is then simulated on an analog computer; its dynamic characteristics are investigated with consideration of various environmental effects. (Key words: Computers, analog; plants; soil moisture.) [ABSTRACT FROM AUTHOR]

The stomata of plant leaves constitute a main regulating system of the transpiration process. Biologists have suggested a turgor mechanism to explain stomatal movement. The functions of the mechanism are quantitatively described by an osmotic water transfer theory and/or the active water transfer theory in the guard cells. Based on the active water transfer theory and the observations of stomatal movement under various conditions of H2O, CO2, and light, a conceptual model of the stomatal control mechanism is proposed. Transfer functions of the mechanisms characterizing the changes in turgor pressure have been derived. The entire system has been organized by the application of adaptive control system theory and has been simulated on an analog computer. The dynamic characteristics have been investigated with consideration of various environmental conditions. (Key words: Computers, analog; plants; soil moisture.) [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses alternative approaches for assessing and draining obstructed ducts that includes the combined endoscopic and percutaneous technique called rendezvous procedure.

Ginsenosides, the major active ingredient of ginseng, show a variety of biomedical efficacies such as anti-aging, anti-oxidation and anti-inflammatory activities. To understand the effects of 20-O-β-D-glucopyranosyl-20 (S)-protopanaxadiol (compound K), one of the major metabolites of ginsenosides on the skin, we assessed the expression level of approximately 100 transcripts in compound K-treated HaCaT cells using cDNA microarray analysis. Compound K treatment induced differential expression of 40 genes, which have been reported to be involved in the organization of the structure of the extracellular matrix as well as defense responses in human skin cells. One of the most interesting findings is a two-fold increase in hyaluronan synthase2 (HAS2) gene expression by compound K. We found that change in expression of HAS2 gene represents a specific response of HaCaT cells to compound K because hyaluronan synthase 1,3 was not changed by treatment with compound K. We also demonstrated that the compound K effectively induced hyaluronan synthesis in human skin cells and hairless mouse skin. A human clinical study indicated that topical application of compound K containing oil-in-water emulsion showed improvement of xerosis, wrinkle and fine lines in the aged skin. We concluded that compound K has anti-aging effects by the induction of HAS2 gene expression and following hyaluronan synthase. [ABSTRACT FROM AUTHOR]

Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face-to-face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted., (© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Salvage chemotherapy followed by autologous stem cell transplant (ASCT) remains the current standard of care for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) with chemosensitive disease. The addition of rituximab results in improved overall survival (OS) after first-line treatment, but cure rates of salvage therapy with ASCT are inferior when compared to historical controls. Historically, patients with DLBCL with disease progression following ASCT have had an extremely poor prognosis with a median OS of 3 months. However, there are little data regarding outcomes in the rituximab era. We performed a retrospective study of 56 patients with relapsed or refractory DLBCL with prior exposure to rituximab who had disease progression following ASCT. The median OS from progression following ASCT for the cohort was 9.9 months (95% CI: 5.3-13.1 months). Patients who progressed less than 1 year from ASCT had a significantly shorter OS than those who progressed at 1 year or greater from ASCT (8.2 vs. 26.7 months, P = 0.01). Patients with at least stable disease following ASCT had a longer OS than those who progressed immediately after ASCT (12.3 vs. 5.3 months, P = 0.01). Other factors associated with OS were International Prognostic Index (IPI) (P = 0.01) and LDH level (P = 0.0003) at the time of progression following ASCT. In the rituximab era, the prognosis for patients with disease progression following ASCT remains poor, but is improved when compared with historical controls. Ultimately, more work needs to be done to develop novel therapeutic strategies tailored to individual patients in this heterogeneous population., (Copyright © 2013 Wiley Periodicals, Inc.)

Background/methods: Molecular Adsorbent Recirculating System (MARS) was used in three consecutive critically ill patients at the Singapore General Hospital with advanced malignancy and acute liver failure (ALF). Case 1 was a male patient with hepatocellular carcinoma (HCC) for which initial right hepatectomy was followed by left hepatectomy 5 months later for recurrent HCC. The postoperative course following second surgery was complicated by severe methicillin-resistant Staphylococcus aureus (MRSA) sepsis, mild azotaemia and subacute cholestatic liver failure. MARS was used thrice in this patient. Case 2 was a female patient with advanced acute lymphoblastic leukaemia (ALL) with post bone marrow transplantation (BMT) acute haemolytic-uraemic syndrome (HUS) secondary to cyclosporin A (Cy A), cytomegalovirus (CMV) infection, severe nosocomial pneumonia, acute renal failure (ARF) treated with continuous haemofiltration and acute veno-occlusive disease resulting in Budd-Chiari syndrome. The latter precipitated ALF. MARS was instituted twice. Case 3 was a male patient with advanced, refractory Hodgkin's disease previously treated with multiple courses of chemotherapy. ALF developed secondary to acute viral hepatitis B flare. He was given a trial of MARS once in the ICU. All the three patients eventually died., Results: Mean MARS intradialytic systemic pressures were as follows: systolic pressure range was 95 +/- 17 to 128 +/- 17 mmHg and diastolic pressure range was 51 +/- 5 to 67 +/- 7 mmHg. Pressure at albumin dialysate exit point from dialyser 1 (Ae) ranged from 253 +/- 11 to 339 +/- 15 mmHg and that at albumin dialysate entry point into dialyser 1 (Aa) ranged from 142 +/- 11 to 210 +/- 6 mmHg. Ultrafiltration (UF) was 633 +/- 622 mL over mean treatment duration of 6.3 +/- 0.9 h with a total heparin dose of 1583 +/- 817 IU. Coagulation status pre- and 6-h post-MARS was similar: aPTT (P=0.116) and platelet count (P=0.753). There were no bleeding complications or circuit thromboses. MARS had a significant de-uraemization effect (pre- and post-MARS serum creatinine and urea: P=0.046 and 0.028, respectively) but did not significantly attenuate blood lactate, ammonia or total bilirubin levels. Albumin dialysate (Ae - Aa) urea and creatinine concentrations appeared to be sharply attenuated after 6 h of MARS. In contrast, the removal of total bilirubin by albumin dialysate from the blood compartment appeared to plateau after 4 h of continuous MARS operation., Conclusions: MARS was well-tolerated in critically ill patients with advanced and complicated cancer. Low-dose heparin was safe and did not compromise MARS circuit integrity. Although MARS had a significant de-uraemization effect, this appeared to be limited by the duration of MARS operation. Our data suggested that such a limit was reached earlier for total bilirubin. More data are needed to confirm the present findings and further delineate the saturation limit of MARS for different toxins that accumulate in ALF. This would affect the optimal duration of MARS therapy.

1. Angiotensin converting enzyme (ACE) inhibitors are in common use for the treatment of hypertension and heart failure. Whereas they are, in general, well tolerated, a dry cough can develop which, on occasion, requires termination of therapy. The reported prevalence of cough with ACE inhibitor therapy has varied from 0.2 to 25%, depending upon methods of data collection, analysis and symptom reporting. 2. To evaluate the prevalence of cough in Chinese patients receiving ACE inhibitors, interviews were carried out in 191 patients in Hong Kong who were taking therapy which included captopril or enalapril for hypertension or heart failure, and 382 patients matched for sex and age receiving alternative medications which excluded an ACE inhibitor (controls). Patients and controls were interviewed in a blinded manner by the same interviewer using a common adverse-effect questionnaire. 3. Persistent cough was reported in 44% of patients taking an ACE inhibitor (46% of those receiving captopril and 41.8% of patients taking enalapril), and in 11.1% of the controls (P < 0.001). The prevalence of other adverse reactions was similar, with no significant difference between the two treatment groups. The complication of cough was not related significantly to age, sex, underlying disease, drug dosage or smoking status. 4. This study indicates that cough is a common side effect of treatment with ACE inhibitors in Hong Kong Chinese, although in most patients cessation of therapy is not required. Whether Chinese are particularly susceptible to ACE-inhibitor cough requires a formal prospective study comparing Chinese and non-Chinese patients.

1. The reproducibility of angiotensin converting enzyme inhibitor induced cough was examined in a double-blind cross over study in patients previously shown to have exhibited this side effect. 2. Ninety-seven patients who had experienced angiotensin converting enzyme inhibitor cough within the last 2 years were challenged with enalapril 20 mg daily for 4 weeks to establish eligibility. Eighty-eight of 97 (91%) patients experienced a repeat of their cough symptoms. Sixty-four patients entered the double-blind part of the study where they were treated with enalapril 20 mg and a renin inhibitor for up to 4 weeks in random order. These periods were separated by a minimum 4 week placebo wash out. 3. Of 59 evaluable patients who received enalapril a second time, 37 (62.7%) experienced cough again. Of 62 patients on the renin inhibitor 16 (25.8%) experienced cough, however as it was not equi-efficacious to enalapril no valid comparison could be made. 4. Angiotensin converting enzyme inhibitor cough is not reproducible within patients, as other factors are involved in the aetiology. Objective testing with blinded assessment together with symptom reporting, would give a more accurate measure of the incidence, and mechanism of this side effect.