คลินิกจัดฟันแบริ่ง

The advantages of angiotensin II antagonism. At the end of our 6-year clinical trial, nine participants had reached the primary GFR outcome for an HR of 0.50 (95% CI 0.12–1.99) in those assigned to losartan versus placebo (7). 1995 Dec;8(12 Pt 1):1177-83. doi: 10.1016/0895-7061(95)00361-4. Please enable it to take advantage of the complete set of features! ESRD was defined by the initiation of renal replacement therapy or death from diabetic kidney disease if the participant refused dialysis. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The Collaborative Study Group, Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy, Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes, Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group, The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes, The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group, Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency, An acute fall in estimated glomerular filtration rate during treatment with losartan predicts a slower decrease in long-term renal function, initial angiotensin receptor blockade-induced decrease in albuminuria is associated with long-term renal outcome in type 2 diabetic patients with microalbuminuria: a post hoc analysis of the IRMA-2 trial, KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update, The Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) observational follow-up study: benefits of RAS blockade with olmesartan treatment are sustained after study discontinuation, Adjusting for treatment effects in studies of quantitative traits: antihypertensive therapy and systolic blood pressure, Long-term effects of ramipril on cardiovascular events and on diabetes: results of the HOPE study extension, Long-term hemodynamic and molecular effects persist after discontinued renin-angiotensin system blockade in patients with type 1 diabetes mellitus, Changing patterns of type 2 diabetes incidence among Pima Indians, Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians, Predominant effect of kidney disease on mortality in Pima Indians with or without type 2 diabetes, Regression to the Mean Contributes to the Apparent Improvement in Glycemia 3.8 Years After Screening: The ELSA-Brasil Study, Postintervention Effects of Varying Treatment Arms on Glycemic Failure and β-Cell Function in the TODAY Trial, Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000–2015, Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc16-0795/-/DC1, http://www.diabetesjournals.org/content/license. Reliance on renal function changes or on surrogate markers such as albuminuria may not be sufficient to adequately evaluate renoprotection in early diabetic kidney disease even after many years of follow-up. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. R.G.N. Duality of Interest. Likewise, Ang 1-7 as a physiologic antagonist of AT1 and losartan could possibly protect the kidney against I/R damage. wrote the draft of the report and performed the statistical analysis. RESULTS After completion of the clinical trial, treatment with renin-angiotensin system inhibitors was equivalent in both groups. Of the 169 participants in the clinical trial, 149 remained under observation in the posttrial period (12 died and 8 were lost to follow-up during the clinical trial). Blocking angiotensin II widens (dilates) blood vessels which lowers blood pressure. NCI CPTC Antibody Characterization Program. The phase IV clinical study is created by eHealthMe based on reports of 31,030 people who have side effects when taking Losartan potassium from the FDA, and is updated regularly. This research was supported by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases, the American Diabetes Association (Clinical Science Award 1-08-CR-42), and Merck, which provided the study drug and placebo tablets. Participants with type 2 diabetes who were randomized to tight blood pressure control with either captopril or atenolol in the UKPDS had a 29% reduction in risk of urinary albumin concentration ≥50 mg/L during the trial (5), but this effect was not sustained long term (6). As no significant interaction was found between treatment assignment and albuminuria group (P = 0.20), the overall treatment effect was estimated. and K.M.W. Closing date for the clinical trial was determined either by date of last examination during the randomized treatment study or by date of biopsy for those who agreed to a kidney biopsy. Lowering blood pressure may reduce the risk of strokes and heart attacks. Angiotensin II, independent of plasma renin activity, contributes to the hypertension of autonomic failure. RAS inhibition reduces the risk of ESRD in persons with type 1 (11) and type 2 diabetes (12–14) who have chronic kidney disease and in those with other causes of chronic kidney diseases (15), but its effect on protection from ESRD in early diabetic kidney disease is less well established. In the normoalbuminuria group, the HR for the first appearance of elevated albuminuria (ACR ≥30 mg/g) among those receiving losartan versus placebo was 1.02 (95% CI 0.65–1.62), and for the appearance of macroalbuminuria, the HR was 1.40 (95% CI 0.71–2.78). Progression to macroalbuminuria (ACR ≥300 mg/g) was examined as a secondary outcome. NLM The median follow-up time to development of macroalbuminuria was 10.1 years (interquartile range 3.3–15.6 years). This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Although the number of ESRD events was insufficient for informative analyses, the HR for death in those receiving losartan versus placebo was 0.79 (95% CI 0.47–1.32) and for either ESRD or death was 0.88 (95% CI 0.56–1.40). The Epidemiology of Diabetes Interventions and Complications (EDIC) study showed significant sustained reduction in risk of impaired glomerular filtration rate (GFR) (1) and nephropathy during the posttrial period in participants with type 1 diabetes who received intensive glucose control for 6.5 years (2). Your risk may be higher if: you have poor kidney function; are a senior; take a water pill; are dehydrated Which One to Give? Salt-dependent renal effects of an angiotensin II antagonist in healthy subjects. Kirsty, Losartan is known to cause an increase in creatinine but as long as it is a small increase, the consultants accept this as a side effect of the medication and not significant as a problem with your kidney function as such. Ultimately, in this underpowered study, it is difficult to disentangle whether our findings indicate no benefit of early RAS blockade on diabetic kidney disease or whether any benefit that may be present, particularly if small, was masked by the use of RAS inhibitors in the placebo group. The 2-year follow-up interval was selected because it represented the median time interval between the last GFR measurement and the onset of ESRD in the study cohort. Adjustment for age, sex, diabetes duration, MAP, GFR, and ACR did not significantly alter our results (HR 0.88 [95% CI 0.52–1.48]). Why? wrote the draft of the report and designed the clinical trial. Death occurred in 58 participants (32 were randomized to placebo and 26 to losartan) and in 11 was preceded by ESRD. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 1996 Mar;90(3):205-13. doi: 10.1042/cs0900205. We examined the renal hemodynamic modifications induced by a selective angiotensin II (AII) AT1 receptor antagonist, losartan, in 10 patients with essential hypertension. At the end of the 6-year trial, 111 participants agreed to a kidney biopsy to determine the effect of losartan on glomerular structure. Losartan potassium is a prescription medication commonly used to lower blood pressure in people with hypertension (high blood pressure). The current study further illustrates the challenges of establishing whether RAS inhibition clearly provides renoprotection in early type 2 diabetes, because a statistically significant reduction in clinical outcomes was not observed even after ∼14 years of follow-up, and long-term follow-up of larger antihypertensive drug trials is rarely attempted. In contrast, mesangial fractional volume at the end of the trial was lower in participants with microalbuminuria who were assigned to losartan than in those who were assigned to placebo (7). In this setting, a commonly used approach of fitting the regression model with RAS inhibitor treatment as a binary variable is not valid (20). Treatment with losartan attenuated CIH-induced renal tissue damage, suggesting that activation of RAS is the primary cascade involved in CIH-induced kidney injury. Additional follow-up of this cohort is needed to determine the long-term effect of early treatment on the risk of ESRD or death. Losartan is also used to slow long-term kidney damage in people with type 2 diabetes who also have high blood pressure. Each participant provided written informed consent. Given the apparent structural preservation associated with early losartan treatment, we hypothesized that early treatment would provide an extended benefit in reducing the risk of GFR decline in diabetic kidney disease, similar to that observed for early intensive glycemic control. Schmitt F, Natov S, Martinez F, Lacour B, Hannedouche TP. It works by blocking a substance in the body that causes blood vessels to tighten. Losartan is an angiotensin II receptor blocker (ARB). MAP and HbA1c throughout the study period were compared between treatment groups using mixed models to account for serial correlations over time. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc16-0795/-/DC1. Acute kidney failure is found among people who take Losartan potassium, especially for people who are female, 60+ old, have been taking the drug for 5 - 10 years. Losartan may also be used for purposes not listed in this medication guide. Times to outcomes were compared by treatment group using Kaplan-Meier survival curves and the log-rank test. Long-term benefit on nephropathy of early intervention with antihypertensive drugs, however, has not been demonstrated in persons with diabetes, despite the presence of potential mechanisms induced by early treatment with renin-angiotensin system (RAS) inhibitors that might result in a persistent benefit (4). During the trial, nine persons reached the primary outcome with a hazard ratio (HR; losartan vs. placebo) of 0.50 (95% CI 0.12–1.99). Exposure to RAS inhibitors in the posttrial follow-up was equivalent to 67% of the total person-time in the placebo group and 63% of the total person-time in the losartan group. Further, losartan is FDA-approved to treat kidney damage in people who have type 2 diabetes, a condition that occurs when the body does not use insulin effectively and blood glucose (sugar) rises too high. Chida R, Hisauchi I, Toyoda S, Kikuchi M, Komatsu T, Hori Y, Nakahara S, Sakai Y, Inoue T, Taguchi I. Hypertens Res. Although these HRs are not directly comparable, they both suggest no beneficial effect of early treatment with losartan on progression of diabetic kidney disease in Pima Indians with type 2 diabetes. Where no interaction was present, the analysis was stratified by baseline albuminuria status to account for the stratified sampling design, and the overall results were generally reported for both albuminuria groups combined. The effects of angiotensin II receptor blockade with losartan on systemic blood pressure and renal and extrarenal prostaglandin synthesis in women with essential hypertension. Where an interaction was present, results were reported separately by baseline albuminuria status. 222–231 Losartan-sensitive renal damage caused by chronic NOS inhibition does not involve increased renal angiotensin II concentrations A. MARJAN G. VERHAGEN, BRANKO BRAAM, PETER BOER, HERMANN-JOSEF GRO¨NE, HEIN A. KOOMANS, and JAAP A. JOLES Department of Nephrology, University Hospital Utrecht, The Netherlands, and the Department of …  |  No potential conflicts of interest relevant to this article were reported. Funding. But it also can worsen kidney function so if you are going to start this med then kidney function should be watched closely. Sign In to Email Alerts with your Email Address. When analyzed separately, the HR was 1.04 (95% CI 0.48–2.25) for the normoalbuminuria group and 0.56 (0.29–1.07) for the microalbuminuria group. However, during the subsequent follow-up, adherence to annual research examinations declined, and 15 participants progressed to ESRD without documentation of reaching the primary GFR outcome at a research examination. It is also used to lower the risk of strokes in patients with high blood pressure and an enlarged heart. Several studies have shown that renin angiotensin (Ang) system and activation of Ang II type 1 receptor (AT1) are involved in various forms of kidney diseases. We suggested that use of losartan in risk situations, like old age, preexiting CRF, stenosis of renal arteries, solitary kidney and diuretic therapy, should be carefully monitored as well as that of ACE I. During the clinical trial, we found that the HR for macroalbuminuria in those treated with losartan versus placebo was 8.12 (95% CI 1.02–64.98) among participants with normoalbuminuria and 0.54 (95% CI 0.26–1.10) among those with microalbuminuria at enrollment (7). no. © 2021 by the American Diabetes Association. For outcomes determined independently of the annual research examinations (ESRD and death), follow-up time accumulated from enrollment into the trial until the date of the event or 31 December 2015, whichever came first. Losartan helps the kidneys in certain conditions like diabetes. Twenty-six participants progressed to ESRD during follow-up (11 were randomized to placebo and 15 to losartan). Epub 2015 Jul 16. In conclusion, we want pointed out that losartan could affect renal function in a similar way as angiotensin converting enzyme inhibitors (ACEI). Log-rank test for the GFR outcome yielded P = 0.28. Moreover, ABP monitoring has been found to be more closely related to target organ damage 20, 21 and to cardiovascular mortality than clinic BP 22, 23. In this single-blind study, renal hemodynamic parameters were determined twice (patients were their own controls) first after a 15-day single-blind placebo run-in period and again after a 1-month losartan period. There was a significant difference in MAP by treatment group throughout the study period (P = 0.04), but not for HbA1c. Author Contributions. OBJECTIVE To determine whether early administration of losartan slows progression of diabetic kidney disease over an extended period. We selected 170 Pima Indians with type 2 diabetes from the Gila River Indian Community (8) to participate in a 6-year, single-center, randomized, double-blind, clinical trial testing the renoprotective efficacy of losartan (Cozaar; Merck) in early diabetic nephropathy. Parts of this study were presented in abstract form at the 76th Scientific Sessions of the American Diabetes Association, New Orleans, LA, 10–14 June 2016. During the clinical trial (7), 97.5% of research examinations were conducted according to the prespecified examination schedule. It is also used to treat kidney problems in patients with type 2 diabetes and a history of hypertension. Of the 170 participants randomized in the clinical trial, one had no follow-up measurements and was excluded from analysis (7). An interaction term between treatment assignment and baseline albuminuria group was included to test whether the relationship between treatment and outcomes differed by baseline albuminuria status. Among the 51 participants with microalbuminuria who had a kidney biopsy at the end of the clinical trial, those who received losartan during the 6-year trial had lower mesangial fractional volume and higher filtration surface area than those who received a placebo. The National Library of Medicine (NLM), on the NIH campus in Bethesda, Maryland, is the world's largest biomedical library and the developer of electronic information services that delivers data to millions of scientists, health professionals and members of the public around the globe, every day. Combining Blood Pressure Drugs May Increase Kidney Damage Risk November 19, 2013 Written by: Martha Garcia 1 Comment; New research suggests that … Clipboard, Search History, and several other advanced features are temporarily unavailable. I … There was no such interaction for MAP (P = 0.42), but there was a significant difference in MAP by treatment assignment (P = 0.04) that was most apparent in the last 3 years of observation, with lower MAP in those assigned to losartan. S.K.T. Long-term Effect of Losartan on Kidney Disease in American Indians With Type 2 Diabetes: A Follow-up Analysis of a Randomized Clinical Trial, Intensive diabetes therapy and glomerular filtration rate in type 1 diabetes, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study at 30 years: advances and contributions, 10-year follow-up of intensive glucose control in type 2 diabetes, Antihypertensive therapy in diabetes: the legacy effect and RAAS blockade, Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38, Long-term follow-up after tight control of blood pressure in type 2 diabetes, Effect of losartan on prevention and progression of early diabetic nephropathy in American Indians with type 2 diabetes, Diabetes mellitus in American (Pima) Indians, Structural Predictors of Loss of Renal Function in American Indians with Type 2 Diabetes, Determination of creatinine by means of automatic chemical analysis, The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. Participants were then followed posttrial for up to 12 years, with treatment managed outside the study. Intervals between research examinations sometimes increased as kidney disease progressed, which could lead to differential misclassification of the study-based outcomes (GFR and albuminuria), requiring an imputation method to compute these outcomes. Kidney International, Vol. performed the statistical analysis. The official page of the U.S. Food and Drug Administration. To account for the acute effects of initiating treatment with RAS inhibitors, GFR measured at each research examination, conducted either during or after the clinical trial at which the participant was treated with a RAS inhibitor, was adjusted upward by 3.75% as described previously (9). Although cozaar is harmful for kidney to some extent, it does not mean all the kidney disease patients should stay far away from this medication. In participants who progressed to ESRD without a GFR measurement indicating that they had reached the GFR outcome, a GFR of zero was assigned as of the date of onset of renal replacement therapy. It is also used to lower the risk of stroke in certain people with heart disease. Would you like email updates of new search results? 56 (1999), pp. © 2016 by the American Diabetes Association. The current consensus, based on several clinical trials, is that RAS inhibition provides no benefit for primary prevention in normoalbuminuric, normotensive patients with diabetes and may actually lead to harm (18). Urine albumin concentrations below the detection limit of the assay (≤6.8 mg/L) were set to 6.8 mg/L in the analyses. Accordingly, we used a preferred approach of adjusting the observed GFR in each participant according to changes in RAS inhibitor treatment during follow-up, and we found that this adjustment did not alter our results. The primary GFR finding, however, was unchanged when the Cox model was adjusted for the 2-mmHg difference in MAP between treatment groups (HR 0.74 [95% CI 0.45–1.21]). Losartan is used to treat high blood pressure (hypertension) and to help protect the kidneys from damage due to diabetes. This medication has the ability to lower the possible risk of a stroke in people suffering from any heart condition. Characteristics at the last clinical trial visit for the 149 participants who remained posttrial were similar between treatment groups (Table 1). Clinical trial reg. A borderline statistically significant interaction was found between treatment group and baseline albuminuria status when examining annual mean HbA1c (P = 0.05), with losartan treatment being associated with higher HbA1c in those with normoalbuminuria but lower HbA1c in those with microalbuminuria. Hazard ratios (HRs) were computed using Cox proportional hazards regression. Urine albumin concentration was measured by nephelometric immunoassay and urine creatinine by a modified Jaffé reaction (Siemens, Erlangen, Germany) (10). The current study additionally included long duration of treatment and a minority population with a high frequency of type 2 diabetes and diabetic kidney disease (23,24), which is not represented in most clinical trials. Ischemia/reperfusion (I/R) is a major cause of acute kidney injury. Liver damage, known as fibrosis, is caused by the unwanted accumulation of excess fibrous connective tissue which is produced and maintained by a specialised cell, the liver myofibroblast. wrote the draft of the report. The lack of a statistically significant reduction in early kidney disease progression in the current study suggests that combined beneficial effects of RAS inhibition in early diabetic kidney disease are, at best, modest. Apart from the UKPDS, which had a median posttrial follow-up duration of 8 years, to our knowledge, no previous long-term follow-up of ACE inhibitor or ARB trials beyond 2–4 years of observation has been reported (19,21,22). We do not capture any email address. Iothalamate concentration was measured in blood and urine samples by high-performance liquid chromatography (Waters, Milford, MA). Am J Cardiovasc Drugs. Participants, who were not selected based on GFR at enrollment, were randomized to receive losartan (100 mg/day) or placebo within each albuminuria stratum. However, as all the western medicines can cause side effects to people and losartan can also cause side effects to people. To avoid the bias (informative censoring) that occurs when loss to follow-up is related to the study outcome, we used linear imputation to estimate the date of onset of the study outcomes (GFR and albuminuria). Doctors prescribe it to treat hypertension and nephropathy, which is damage … Dashed line, placebo; solid line, losartan. Of those alive at the end of the clinical trial, 95% participated in the posttrial follow-up study. Besides, because the medicine contains potassium, which will be harmful for kidney disease patients who have high potassiu… Effects of irbesartan on serum uric acid levels in patients with hypertension and diabetes. Rather than occurrence of any modification in filtration fraction (FF), a significant decrease in microalbuminuria was evident (57 +/- 77 vs. 40 +/- 59 mg/24 h, p < 0.05). In this study, we report results from analyses that include the posttrial period. It prevents the blood vessels in your body from narrowing, thus lowering your blood pressure and improving the blood circulation. designed the clinical trial. Losartan potassium is a type of angiotensin receptor blocker (ARB) known by the brand name Cozaar. GFR was measured after an overnight fast by the urinary clearance of iothalamate (9). The main strengths of this study include the use of measured GFR and the long follow-up period. This site needs JavaScript to work properly. The dosage of losartan was 50 mg/day. Characteristics of the study population at the beginning of posttrial follow-up were compared between treatment groups using an independent samples t test for normally distributed variables and the Kruskal-Wallis test for nonnormally distributed variables. Increase of ROS and NADPH oxidase gives rise to inflammation and injury of renal tubular cells, which promotes CaOx stone formation. Others include pain or weakness in the muscles, confusion, loss of memory, flushing, and rashes. P.-J.S. Standards of care for people with diabetic kidney disease were evolving, and this modification was required by the ethics committee overseeing the study. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. More information is available at http://www.diabetesjournals.org/content/license. Cumulative HRs and 95% CIs for the primary GFR outcome at trial closeout and each year of the posttrial follow-up (bottom panel). Thank you for your interest in spreading the word about Diabetes Care. Furthermore, the risk of kidney disease progressing to ESRD in this population may differ from that in other populations because of poor glycemic control and because of the lower risk of competing cardiovascular deaths prior to the onset of renal replacement therapy (25). R.G.N. Alternative end points, such as structural end points from kidney biopsies, may be required to demonstrate renoprotection in early diabetic kidney disease. The common side effects include dizziness, low blood pressure, skin rashes, diarrhea and migraine. Smith MC, Barrows S, Meibohm A, Shahinfar S, Simpson RL, Weigel K, Dunn MJ. Am J Hypertens. Nakamura M, Sasai N, Hisatome I, Ichida K. Clin Pharmacol. Losartan-sensitive renal damage caused by chronic NOS inhibition does not involve increased renal Ang II concentrations. To study the losartan influence on renal function and uric acid (UA), CRP and baseline immunoreactive insulin (IRI) plasma concentration in essential hypertensive (EH) patients (pts) with hypertensive Chronic Kidney Disease (CKD). Urinary sodium excretion was not modified, but an almost significant (p = 0.07) decrease in proximal sodium reabsorption was observed (72.9 +/- 7.7 vs. 68.1 +/- 6.4% of filtered sodium). Primary outcome was a decline in glomerular filtration rate (GFR; iothalamate) to ≤60 mL/min or to half the baseline value in persons who entered with GFR <120 mL/min. The same approach was used to compute follow-up time and event status for the albuminuria outcome, assuming that development of ESRD also reflected progression to macroalbuminuria. During a median of 13.5 years following randomization, 29 participants originally assigned to losartan and 35 to placebo reached the primary GFR outcome with an HR of 0.72 (95% CI 0.44–1.18). In the microalbuminuria group, the HR for developing macroalbuminuria was 0.68 (95% CI 0.40–1.18). All participants who received a non-RAS inhibitor antihypertensive drug during the posttrial period also received a RAS inhibitor at some point posttrial. Because the acute and chronic effects are different, accounting for them is difficult, particularly when change in GFR is the outcome. In the current study, longer follow-up attenuated these HRs, so that neither effect was statistically significant. 2014 May 3;6:79-86. doi: 10.2147/CPAA.S61462. The Different Therapeutic Choices with ARBs. HbA1c was also measured by high-performance liquid chromatography (Tosoh, Tokyo, Japan). Burnier M, Rutschmann B, Nussberger J, Versaggi J, Shahinfar S, Waeber B, Brunner HR. It also improves your survival if you're taking it … Our study highlights the need for larger studies and long-term follow-up to evaluate the renoprotective efficacy of RAS inhibitors in persons with early diabetic kidney disease or with no clinically apparent kidney disease if currently accepted outcomes are used. Participants in the current study had previously completed a 6-year randomized clinical trial of losartan versus placebo in which few participants reached the primary GFR outcome, and the risk of progression between treatment groups was not statistically significant.

Echo And The Bunnymen, Things To Do This Week In Grand Rapids, La Goulue Menu, Workshop To Rent Near Me, Turkish Meat Dolma Recipe, Love And Hip Hop Full Episodes, Estella Caffe Espresso Machine, Li Hongyi Drama, South Seas Lands End 1625, Pork Rind Seasoning Ingredients,