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Aim The combination of weight excess and hypertension significantly contributes to cardiovascular risk and progressive kidney damage. An unfavorable renal hemodynamic profile is thought to contribute to this increased risk and may be ameliorated by direct renin inhibition (DRI). The aim of this trial was to assess the effect of DRI on renal and systemic hemodynamics and on RAAS activity, in men with weight excess and hypertension. Methods A randomized, double-blind, cross-over clinical trial to determine the effect of DRI (aliskiren 300 mg/day), with angiotensin converting enzyme inhibition (ACEi; ramipril 10 mg/day) as a positive control, on renal and systemic hemodynamics, and on RAAS activity (n = 15). Results Mean (SEM) Glomerular filtration rate (101 (5) mL/min/1.73m2) remained unaffected by DRI or ACEi. Effective renal plasma flow (ERPF; 301 (14) mL/min/1.73m2) was increased in response to DRI (320 (14) mL/min/1.73m2, P = 0.012) and ACEi (317 (15) mL/min/1.73m2, P = 0.045). Filtration fraction (FF; 34 (0.8)%) was reduced by DRI only (32 (0.7)%, P = 0.044). Mean arterial pressure (109 (2) mmHg) was reduced by DRI (101 (2) mmHg, P = 0.008) and ACEi (103 (3) mmHg, P = 0.037). RAAS activity was reduced by DRI and ACEi. Albuminuria (20 [9–42] mg/d) was reduced by DRI only (12 [5–28] mg/d, P = 0.030). Conclusions In men with weight excess and hypertension, DRI and ACEi improved renal and systemic hemodynamics. Both DRI and ACEi reduced RAAS activity. Thus, DRI provides effective treatment in weight excess and hypertension. Trial Registration Dutch trial register, registration number: 2532 www.trialregister.nl

There is no evidence from randomised clinical trials with regard to the question if and when to resume antithrombotic medication in patients who have suffered an intracerebral haemorrhage and in whom medication continues to be indicated. It is unknown whether new oral anticoagulants are more suitable than vitamin K antagonists in this group of patients. Oral anticoagulants should probably not be resumed in patients with a lobar intracerebral haemorrhage caused by cerebral amyloid angiopathy. They can be considered in patients with a haemorrhage in subcortical regions of the brain, the brain stem or the cerebellum, provided that blood pressure levels are under control. Depending on the risk of a cardiac embolus, antithrombotic medication can be resumed from 1 to 10 weeks after the intracerebral haemorrhage. In patients with atrial fibrillation this risk can be calculated using the CHA2DS2-VASc score. In patients with a cardiac indication for antithrombotic medication the decision whether or not to resume medication should be made by a cardiologist and a neurologist in collaboration.

Thus far no effective treatment for an intracerebral haemorrhage has been available. A randomized clinical trial recently showed that treatment of hypertension in the acute phase of spontaneous intracerebral haemorrhage with a target systolic blood pressure of 140 mmHg is safe and improves prognosis. The effect of blood pressure reducing therapy was small and not statistically significant for the primary outcome (mortality or severe morbidity). Moreover, this effect was shown in one trial only. Therefore the clinical relevance of these study results remains debatable. Considering all available arguments, in patients with a systolic blood pressure150 mmHg in the first 6 hours after spontaneous intracerebral haemorrhage the Dutch Neurovascular Working Group recommends lowering the blood pressure to a target systolic level of 140 mmHg within 1 hour and maintaining this target level for 1 week. When this strategy is not chosen, we recommend that a systolic blood pressure180 mmHg should be treated anyway, with a target level of 160 mmHg.

The space transportation industry is undergoing tremendous change. Driven by strong market forces and a regulatory shift towards commercialization, entrepreneurial companies plan to introduce the first reusable launch vehicles. In the absence of aviation-style certification procedures, industry participants are working with the FAA to establish a new licensing regime that will foster this nascent industry while safeguarding the public. As one of the major entrepreneurial startups, Rotary Rocket Company is addressing safety by selecting risk mitigation as the development team's primary success criterion and by designing the company's Roton space vehicle like an aircraft. The company's fully reusable, piloted vehicle will undergo a staged development and flight-test program to reduce operational risk. Flight data and the company's accumulated design experience will be used to evolve into a formal certification process as the industry matures.

Chronic therapy of a patient with Nelson's syndrome for 2 years with 300 μg SMS 201–995 per day resulted in a significant decrease in circulating ACTH levels, normalization of the visual field defect and of loss of visual acuity of one eye, and stabilization of tumour growth, without radiological evidence of shrinkage of the pituitary tumour. In two other patients with Nelson's syndrome, SMS 201–995 acutely inhibited circulating ACTH levels. This effect could be shown best if cortisol replacement was temporarily withheld. SMS 201–995 did not affect plasma ACTH and cortisol levels in three patients with untreated Cushing's disease.