Favorable Safety Experience of Local Dental Anesthesia in ICD Recipients with Cardiac Channelopathies

Abstract Background Dental anesthetic management in implantable cardioverter defibrillator (ICD) recipients with cardiac channelopathies (CCh) can be challenging due to the potential risk of life-threatening arrhythmias and appropriate ICD therapies during procedural time. Objectives The present study assessed the hypothesis that the use of local dental anesthesia with 2% lidocaine with 1:100,000 epinephrine or without a vasoconstrictor can be safe in selected ICD and CCh patients, not resulting in life-threatening events (LTE). Methods Restorative dental treatment under local dental anesthesia was made in two sessions, with a wash-out period of 7 days (cross-over trial), conducting with a 28h - Holter monitoring, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments in 3 time periods. Statistical analysis carried out the paired Student's t test and the Wilcoxon signed-rank test. In all cases, a significance level of 5% was adopted. All patients were in stable condition with no recent events before dental care. Results Twenty-four consecutive procedures were performed in 12 patients (9 women, 3 men) with CCh and ICD: 7 (58.3%) had long QT syndrome (LQTS), 4 (33.3%) Brugada syndrome (BrS), and 1 (8.3%) Catecholaminergic polymorphic ventricular tachycardia (CPVT). Holter analysis showed no increased heart rate (HR) or sustained arrhythmias. Blood pressure (BP), electrocardiographic changes and anxiety measurement showed no statistically significant differences. No LTE occurred during dental treatment, regardless of the type of anesthesia. Conclusion Lidocaine administration, with or without epinephrine, can be safely used in selected CCh-ICD patients without LTE. These preliminary findings need to be confirmed in a larger population with ICD and CCh.

Trombo Atrial Esquerdo e Contraste Espontâneo Denso no Uso de Anticoagulante Oral de Ação Direta em Fibrilação Atrial: Visão de Centro Referenciado / Left Atrial Thrombus and Dense Spontaneous Contrast in Direct Oral Anticoagulant Therapy of Atrial Fibrillation: Insights from a Reference Center

Resumo Fundamento No tratamento da fibrilação atrial (FA), a arritmia sustentada mais frequente, com ablação por cateter (ABL) ou cardioversão elétrica (CVE), o período periprocedimento é uma das fases mais críticas. Atualmente, o uso de novos anticoagulantes orais de ação direta (DOAC) é cada vez mais frequente, no entanto, no mundo real, ainda existem poucos dados de estudos sobre a incidência de trombo no átrio esquerdo (TrAE) ou contraste espontâneo denso (CE) no ecocardiograma transesofágico (ETE). Objetivo Analisar a prevalência de TrAE, por ETE, em pacientes em uso de DOAC submetidos à CVE/ABL. Secundariamente: avaliar a associação de comorbidades com a presença de trombos e CE. Métodos Estudo de coorte retrospectivo, unicêntrico, com pacientes do Ambulatório de Arritmia (InCor-HCFMUSP). Foram selecionados e analisados dados clínicos e ecocardiográficos no prontuário da instituição de pacientes com indicação de procedimentos e em uso de DOACs. Considerado um nível de significância de 5%. Resultados Foram incluídos 354 pacientes, no total de 400 procedimentos, de março de 2012-março de 2018. TrAE foi encontrado em 11 pacientes (2,8%), associado com idade avançada (p=0,007) e CHA2DS2-VASc maior (p<0,001). Foi encontrado CE no AE no procedimento antes da ETE em 29 pacientes (7,3%), com menor FEVE (p <0,038) e maior dimensão do AE (p <0,0001). Conclusão A incidência de TrAE e CE em pacientes em uso de DOAC no contexto de CVE/ABL de FA, embora pequena, não é desprezível. Pacientes com escore CHA2DS2-VASc maior, principalmente mais idosos e com diâmetro do AE maior, são mais propensos a esses achados ecocardiográficos.

Abstract Background In the treatment of atrial fibrillation (AF), the most frequently sustained arrhythmia, with catheter ablation (CA) or electrical cardioversion (ECV), the periprocedural period is one of the most critical phases. Currently, the use of new direct action oral anticoagulants (DOAC) is increasingly frequent; however, in the real world, there are still few data on studies on the thrombus incidence in the left atrium (TrLA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE). Objective To evaluate the prevalence of events and association with risk factors in patients using DOACs. Primary objective: to analyze the prevalence of thrombus in the LA by TEE in patients using DOAC undergoing ECV/CA. Second, evaluate the association of comorbidities with the presence of thrombi and DSC. Methods Retrospective cohort, single-center study with patients followed at the Arrhythmia Outpatient Unit (InCor-HCFMUSP). Patients indicated for procedures and using DOACs were selected, and their clinical/echocardiographic data were analyzed. A significance level of 5% was considered. Results 354 patients were included, a total of 400 procedures, from March 2012-March 2018. Thrombus in the LA was found in 11 patients (2.8%), associated with advanced age (p=0.007) and higher CHA2DS2-VASc (p<0.001) score. DSC in the LA before TEE was found in 29 patients (7.3%), with lower LVEF (p<0.038) and greater LA dimension (p<0.0001). Conclusion The incidence of LA thrombus and DSC in patients using DOC in the context of AF ECV/CA, although small, is not negligible. Patients with higher CHA2DS2-VASc scores, especially older and with larger LA diameter, are more prone to these echocardiographic findings.

Peculiaridade dos pacientes com arritmias hereditárias na pandemia pela COVID-19 / Peculiar aspects of patients with Inherited arrhythmias during the COVID-19 pandemic

Resumo Desde dezembro de 2019, observamos o rápido avanço da síndrome respiratória aguda grave causada pelo coronavírus 2019 (SARS-CoV-2). O impacto da evolução clínica de uma infecção respiratória é pouco conhecido em pacientes portadores de arritmias hereditárias, devido à baixa prevalência dessas doenças. Os pacientes que apresentam quadros infecciosos podem exacerbar arritmias primárias ocultas ou bem controladas, por diversos fatores, tais como febre, distúrbios eletrolíticos, interações medicamentosas, estresse adrenérgico e, eventualmente, o próprio dano miocárdico do paciente séptico. O objetivo desta revisão é destacar os principais desafios que podemos encontrar durante a pandemia pela Covid 19, especificamente nos pacientes com arritmias hereditárias, com destaque para a síndrome do QT longo congênito (SQTL), a síndrome de Brugada (SBr), a taquicardia ventricular polimórfica catecolaminérgica (TVPC) e a cardiomiopatia arritmogênica do ventrículo direito.

Abstract Since December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2). The impact of the clinical course of a respiratory infection is little known in patients with hereditary arrhythmias, due to the low prevalence of these diseases. Patients who present with infectious conditions may exacerbate hidden or well-controlled primary arrhythmias, due to several factors, such as fever, electrolyte disturbances, drug interactions, adrenergic stress and, eventually, the septic patient's own myocardial damage. The aim of this review is to highlight the main challenges we may encounter during the Covid 19 pandemic, specifically in patients with hereditary arrhythmias, with emphasis on the congenital long QT syndrome (LQTS), Brugada syndrome (SBr), ventricular tachycardia polymorphic catecholaminergic (CPVT) and arrhythmogenic right ventricular cardiomyopathy.

Ablação por Cateter de Taquicardia Atrial Focal com Ativação Precoce Próxima ao Feixe de His, a Partir da Cúspide Aórtica não Coronária / Catheter Ablation of Focal Atrial Tachycardia with Early Activation Close to the His-Bundle from the Non Coronary Aortic Cusp

Resumo Fundamento A ablação da taquicardia atrial (TA) com local de ativação mais precoce próxima ao feixe de His é um desafio, devido ao risco de bloqueio de AV completo por sua proximidade ao sistema de His-Purkinje (SHP). Uma alternativa para minimizar esse risco é posicionar o cateter na cúspide não coronária (CNC), que é anatomicamente contígua à região para-Hissiana. Objetivos O objetivo deste estudo foi fazer uma revisão de literatura e avaliar as características eletrofisiológicas, a segurança e o índice de sucesso de aplicação de radiofrequência (RF) por cateter na CNC para o tratamento de TA para-Hissiana em uma série de casos. Métodos Avaliamos retrospectivamente dez pacientes (Idade: 36±10 anos) que foram encaminhados para ablação de taquicardia paroxística supraventricular (TPSV) e haviam sido diagnosticados com TA focal para-Hissiana confirmada por manobras eletrofisiológicas clássicas. Para a análise estatística, um P valor d <0.05 foi considerado estatisticamente significativo. Resultados A ativação atrial mais precoce na posição His foi de 28±12ms da onda P, e a CNC foi 3±2ms antes da posição His, sem evidência de potencial His em todos os pacientes. Foi aplicada RF à CNC (cateter de ponta de 4-mm; 30W, 55°C) e a taquicardia foi interrompida em 5±3s sem aumento no intervalo PR ou evidência de um ritmo juncional. Os testes eletrofisiológicos não induziram novamente a taquicardia em 9/10 pacientes. Não houve complicações em nenhum procedimento. Durante o período de acompanhamento de 30 ± 12 meses, nenhum paciente apresentou recorrência de taquicardia. Conclusão O tratamento percutâneo de TA para-Hissiana por meio de CNC é uma estratégia segura e eficiente, tornando-se uma opção interessante para o tratamento de arritmia complexa. (Arq Bras Cardiol. 2021; 116(1):119-126)

Abstract Background Atrial tachycardia (AT) ablation with earliest activation site close to the His-Bundle is a challenge due to the risk of complete AV block by its proximity to His-Purkinje system (HPS). An alternative to minimize this risk is to position the catheter on the non-coronary cusp (NCC), which is anatomically contiguous to the para-Hisian region. Objectives The aim of this study was to perform a literature review and evaluate the electrophysiological characteristics, safety, and success rate of catheter-based radiofrequency (RF) delivery in the NCC for the treatment of para-Hisian AT in a case series. Methods This study performed a retrospective evaluation of ten patients (Age: 36±10 y-o) who had been referred for SVT ablation and presented a diagnosis of para-Hisian focal AT confirmed by classical electrophysiological maneuvers. For statistical analysis, a p-value of <0.05 was considered statistically significant. Results The earliest atrial activation at the His position was 28±12ms from the P wave and at the NCC was 3±2ms earlier than His position, without evidence of His potential in all patients. RF was applied on the NCC (4-mm-tip catheter; 30W, 55ºC), and the tachycardia was interrupted in 5±3s with no increase in the PR interval or evidence of junctional rhythm. Electrophysiological tests did not reinduce tachycardia in 9/10 of patients. There were no complications in all procedures. During the 30 ± 12 months follow-up, no patient presented tachycardia recurrence. Conclusion The percutaneous treatment of para-Hisian AT through the NCC is an effective and safe strategy, which represents an interesting option for the treatment of this complex arrhythmia. (Arq Bras Cardiol. 2021; 116(1):119-126)

Carotid Sinus Massage in Syncope Evaluation: A Nonspecific and Dubious Diagnostic Method / Massagem do Seio Carotídeo na Avaliação da Síncope: Um Método Diagnóstico Inespecífico e Duvidoso

Abstract Background: Carotid sinus hypersensitivity (CSH) is a frequent finding in the evaluation of syncope. However, its significance in the clinical setting is still dubious. A new criterion was proposed by Solari et al. with a symptomatic systolic blood pressure (SBP) cut-off value of ≤ 85 mmHg to refine the vasodepressor (VD) response diagnosis. Objective: To determine and compare the response to carotid sinus massage (CSM) in patients with and without syncope according to standard and proposed criteria. Methods: CSM was performed in 99 patients with and 66 patients without syncope. CSH was defined as cardioinhibitory (CI) for asystole ≥ 3 seconds, or as VD for SBP decrease ≥ 50 mmHg. Results: No differences in the hemodynamic responses were observed during CSM between the groups, with 24.2% and 25.8% CI, and 8.1% and 13.6% VD in the symptomatic and asymptomatic groups, respectively (p = 0.466). A p value < 0.050 was considered statistically significant. During the maneuvers, 45 (45.45%) and 34 (51.5%) patients in the symptomatic and asymptomatic groups achieved SBP below ≤ 85 mmHg. Symptoms were reported especially in those patients in whom CSM caused a SBP decrease to below 90 mmHg and/or asystole > 2.5 seconds, regardless of the pattern of response or the presence of previous syncope. Conclusion: The response to CSM in patients with and without syncope was similar; therefore, CSH may be an unspecific condition. Clinical correlation and other methods of evaluation, such as long-lasting ECG monitoring, may be necessary to confirm CSH as the cause of syncope.

Resumo Fundamento: A hipersensibilidade do seio carotídeo (HSC) é um achado frequente na avaliação da síncope. Entretanto, o valor da resposta positiva é ainda incerto no contexto clínico. Novo critério diagnóstico para tentar refinar a resposta vasodepressora (VD) foi proposto por Solari et al. com determinação da queda sintomática da pressão arterial sistólica (PAS) a níveis ≤ 85 mmHg como ponto de corte. Objetivo: Determinar e comparar a resposta à massagem do seio carotídeo (MSC) em pacientes com e sem síncope de acordo com os critérios vigentes e propostos. Métodos: A MSC foi realizada em 99 pacientes com síncope e 66 pacientes sem síncope. A HSC foi definida como cardioinibitória (CI), se assistolia ≥ 3 segundos, ou VD, se queda da PAS ≥ 50 mmHg. Resultados: Não foram observadas diferenças na resposta hemodinâmica entre os grupos durante a MSC, com 24,2% e 25,8% de resposta CI, e 8,1% e 13,6% de resposta VD nos grupos sintomático e assintomático, respectivamente (p = 0,466). Considerou-se p < 0,05 estatisticamente significativo. Durante as manobras, 45 (45,45%) e 34 (51,5%) pacientes nos grupos sintomático e assintomático atingiram PAS ≤ 85 mmHg. Sintomas foram relatados principalmente por pacientes em que a MSC reduziu a PAS para menos de 90 mmHg e/ou causou assistolia > 2,5 segundos, independentemente do padrão da resposta ou história de síncope prévia. Conclusão: As respostas à MSC em pacientes com e sem síncope foram semelhantes. Portanto, a HSC pode ser uma condição inespecífica. A correlação clínica mais precisa e outros métodos para avaliação, como monitoramento por ECG de longa duração, podem ser necessários para confirmação da HSC como causa da síncope.

Terapia anticoagulante na ablação e cardioversão elétrica da fibrilação atrial / Anticoagulant therapy in ablation and electric cardioversion of atrial ibrillation

tratamento da FA, os pacientes podem ser submetidos a atendimentos eletivos ou de emergência para a reversão do ritmo, incluindo a cardioversão química ou elétrica, bem como o tratamento intervencionista de ablação por cateter, visando a melhora dos sintomas e da qualidade de vida. Em todas as modalidades do tratamento, a terapia anticoagulante oral (ACO) é um dos pilares do tratamento da FA, indispensável para a prevenção de eventos tromboembólicos. A incorporação dos chamados "anticoagulantes de ação direta" (DOAC) no arsenal do tratamento representou um novo paradigma, com estudos randomizados controlados e as evidências de mundo real demonstrando resultados de eficácia e segurança comparáveis com relação à varfarina, com a vantagem de menor interação medicamentosa e alimentar e menor risco de hemorragias catastróficas. O uso de DOAC para o manejo de pacientes que serão submetidos ao procedimento de ablação por cateter para o tratamento intervencionista da FA ou cardioversão elétrica/química é hoje uma realidade cada vez mais presente e tem respaldo dos estudos randomizados controlados e das experiências em vários centros hospitalares mundiais, com esquema e programação mais simples e melhor comodidade no manejo da anticoagulação

Atrial fibrillation (AF) is the most frequent sustained arrhythmia in clinical practice. During the course of AF, patients may be submitted to elective or emergency approaches for rhythm reversal, including pharmacological or electrical cardioversion, as well interventional treatment with catheter ablation, to improve the symptoms and quality of life. In all treatment modalities, it is important to emphasize that oral anticoagulant therapy (OAC) is one of the pillars of AF treatment, and is indispensable for preventing thromboembolic events. The incorporation of so-called "direct oral anticoagulants" (DOACs) into the arsenal of treatment represented a new paradigm, with randomized controlled trials and real-world clinical evidence demonstrating comparable efficacy and safety to warfarin, with the advantage of less drug and food interaction and less risk of catastrophic bleeding. The use of DOACs for the management of patients undergoing catheter ablation for interventional AF treatment or electrical/pharmacological cardioversion is increasingly used and supported by randomized controlled trials and experiences in several worldwide hospital centers, with a simpler regimen and programming and easier management of anticoagulation

Comparison of Therapeutic Efficacy of Rosuvastatin versus Atorvastatin for Blood Lipid,Atherosclerosis and Vascular Endothelial Vasodilation of Patients with Coronary Heart Disease / 中国药房

OBJECTIVE:To compare therapeutic efficacy of rosuvastatin vs. atorvastatin for blood lipid,atherosclerosis and vascular endothelial vasodilation in patients with coronary heart disease(CHD). METHODS:A total of 150 CHD inpatients select-ed from cardiovascular medicine department of our hospital during Jan. 2014-Dec. 2015 were divided into rosuvastatin group (72 cases)and atorvastatin group(78 cases)according to lottery method. All patients were adjusted to living habits,given antiplatelet and blood pressure regulating drugs and other basic treatment. At the same time,rosuvastatin group was given Rosuvastatin calcium tablets 10 mg,po,once a night;atorvastatin group was given Atorvastatin calcium tablets 20 mg,po,once a night. Both groups received treatment for 6 months. The levels of blood lipid indexes (TC,TG,HDL-C,LDL-C),IMT,Crouse scores,Gensini scores and the changes of brachial artery diameter(D)were compared between 2 group before and after treatment. The occurrence of ADR was recorded. RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups(P>0.05). After treatment,the levels of TC,TG,LDL-C,IMT,Crouse scores and Gensini scores in 2 groups were decreased signifi-cantly,while the levels of HDL-C and D values were increased significantly,compared to before treatment;the levels of TC,TG, LDL-C,Crouse score and Gensini score in rosuvastatin group were significantly lower than atorvastatin group,and D value was significantly higher atorvastatin group,with statistical significance(P<0.05). There was no statistical significance in the levels of HDL-C or IMR between 2 groups (P<0.05). During treatment,dizziness occurred in a patient of rosuvastatin group and relieved spontaneously. Four patients in each group had slight elevation of transaminase,and could be reduced to normal after liver protec-tion treatment. CONCLUSIONS:Rosuvastatin shows more significant therapeutic efficacy than that of atorvastatin in reducing blood lipid,improving AS and vascular endothelial vasodilation in CHD patients with good satety.

The study of the role of candesartan in radiosensitivity of nasopharyngeal carcinoma CNE1 cells / 实用医学杂志

Objective To explore the influence of candesartan (an angiotensin II receptor 1 antagonist,AT1R) in radioresistance of human nasopharyngeal carcinoma CNE1 cells.Methods Cell growth of CNE1 with or without candesartan treatment was measured in vitro by MTT method;radiosensitivity of CNE1 with or without candesartan treatment was tested under normoxic or hypoxic conditions by clone formation assay.The expression of hypoxia-induced factor 1α(HIF-1α)in CNE1 cells was analysed by western blotting.Results Candesartan did not significantly inhibit the growth of CNE 1 cells in both normoxic and hypoxic conditions.Candesartan also did not influence the radiosensitivity of CNE1 cells in normoxic condition;however,it significantly increased the radiosensitivity of CNE1 cells in hypoxic condition.The expression of hypoxia-induced factor 1 α (HIF-1 α)in hypoxic CNE1 cells was significantly inhibited by candesartan treatment.Conclusion Candesartan does not significantly influence the proliferation of CNE1 cells in both normoxic and bypoxic conditions but significantly enhances the radiosensitivity of hypoxic CNE1 cells,in which the mechanisn may be involved in its inhibiting HIF1α expression in hypoxic CNE1 cells.

Mir-483 enhances the proliferation,invasion and migration of nasopharyngeal carcinoma cells / 实用医学杂志

Objective To investigate the effects of mir?483 on the proliferation,invasion and migration of nasopharyngeal carcinoma cells . Methods RT?qPCR was used to detect mir?483 expression level in different nasopharyngeal carcinoma cells(CNE?1,CNE?2)and the alteration of mir?483 expression level in these cells after radiation. CNE?1,one of the NPC cells,was selected. Cationic liposomes transient transfection was used to construct cells which overexpressed mir?483 or negative control . MTT assay was conducted to test the cell proliferation ability. Wound scratch assay and transwell migration assay were used to detect the effects of mir?483 on NPC invasion and migration ability. Results In terms of radiation resistance ,the expression level of mir?483 was higher in CNE?1. Overexpressing mir?483 can enhance the proliferation ,invasion and migration ability of CNE?1. Conclusions Mir?483 enhances the proliferation,invasion and migration ability of nasopharyngeal carcinoma cells.

Quais as medicações antiarrítmicas indicadas para o tratamento da taquicardia ventricular no paciente com cardiopatia estrutural? / Which antiarrhythmic drugs are indicated for the management of ventricular tachycardia in patients with structural heart disease?

As taquicardias ventriculares são as arritmias cardíacas com maior potencial de instabilidade clínica e mortalidade cardíaca. Embora possam ocorrer no contexto de pacientes sem cardiopatia estrutural demonstrável, quase sempre ocorrem em coração estruturalmente alterado, com substrato anatômico para reentradas. As alterações cardíacas podem ser isquêmicas e não isquêmica. A distinção entre as etiologias é importante por terem diferentes mecanismos e origens de taquicardia ventricular, que irá determinar a escolha do tratamento adequado das arritmias ventriculares e prevenção de morte súbita. Os principais objetivos no manejo destes pacientes são: a reversão imediata da taquicardia, a prevençãode recorrências e a redução da mortalidade cardiovascular. Atualmente os fármacos com eficácia e perfil de segurança mais utilizados para tratamento de taquicardia ventricular em pacientes com cardiopatia estrutural são os betabloqueadores, amiodarona e sotalol. Com exceção dos betabloqueadores, os antiarrítmicos não possuem a eficácia em manejo primário ou na prevenção de morte súbita demonstrada em estudos clínicos randomizados atuais de forma consistente. Em portadores de cardiodesfibrilador implantável, os antiarrítmicos podem atuar na supressão das taquicardias ventriculares não sustentadas e sustentadas, na lentificação das taquicardias ventriculares com intuito de facilitar a reversão por antitachycardia pacing e prevenir sincopes, além de controlas as taquicardias supraventriculares. Devido aos efeitos colaterais e potencial efeito pró-arrítmico, devem ser utilizados com precaução e com controle adequado...

Ventricular tachycardia is the cardiac arrhythmia with the most potential to result in clinical instability and cardiac mortality. Although it can occur in patients without structural heart disease, it tends to occur where there is underlying heart disease, with anatomical substrate for reentry. It can be subdivided into ischemic and non-ischemic. This is an important distinction, because the mechanisms and origins of ventricular tachycardia may differ between the two, which will determine the choice of treatment for the ventricular arrhythmia and help prevent sudden death. The objective in clinical management of these patients includes: immediate reversal of tachycardia, prevention of relapses, and reducing cardiovascular mortality. The beta-blockers amiodarone and sotalol are currently the most commonly used antiarrhythmic agents, with the best efficacy and safety profile for treating ventricular tachycardia in patients with structural heart disease. With the exception of beta-blockers, currently available antiarrhythmic drugs have not been shown, in randomized clinical trials, to be effective in the primary management of patients with life-threatening ventricular arrhythmias or in the prevention of sudden cardiac death. Inpatients with implantable cardioverter-defibrillators, the potential beneficial effects of antiarrhythmic drugs may be the suppression of non-sustained and sustained ventricular tachycardias, slowing of ventricular tachycardia rate to facilitate pace termination or prevent syncope, and control of atrial tachyarrhythmias. Due to potential adverse effects of antiarrhythmic drugs and the risk of proarrhythmia, close monitoring of the patient is recommended...

Late Outcome of a Randomized Study on Oral Magnesium for Premature Complexes / Evolução Tardia de Estudo Randomizado com Uso de Magnésio Via Oral em Extrassístoles Sintomáticas

Background: Ventricular and supraventricular premature complexes (PC) are frequent and usually symptomatic. According to a previous study, magnesium pidolate (MgP) administration to symptomatic patients can improve the PC density and symptoms. Objective: To assess the late follow-up of that clinical intervention in patients treated with MgP or placebo. Methods: In the first phase of the study, 90 symptomatic and consecutive patients with PC were randomized (double-blind) to receive either MgP or placebo for 30 days. Monthly follow-up visits were conducted for 15 months to assess symptoms and control electrolytes. 24-hour Holter was performed twice, regardless of symptoms, or whenever symptoms were present. In the second phase of the study, relapsing patients, who had received MgP or placebo (crossing-over) in the first phase, were treated with MgP according to the same protocol. Results: Of the 45 patients initially treated with MgP, 17 (37.8%) relapsed during the 15-month follow-up, and the relapse time varied. Relapsing patients treated again had a statistically significant reduction in the PC density of 138.25/hour (p < 0.001). The crossing-over patients reduced it by 247/hour (p < 0.001). Patients who did not relapse, had a low PC frequency (3 PC/hour). Retreated patients had a 76.5% improvement in symptom, and crossing-over patients, 71.4%. Conclusion: Some patients on MgP had relapse of symptoms and PC, indicating that MgP is neither a definitive nor a curative treatment for late follow-up. However, improvement in the PC frequency and symptoms was observed in the second phase of treatment, similar to the response in the first phase of treatment. .

Fundamento: Extrassístoles (ES) ventriculares e supraventriculares são frequentes e muitas vezes sintomáticas. Segundo estudo prévio, a administração de pidolato de magnésio (PMg) a pacientes sintomáticos pode resultar na melhora da densidade das ES e dos sintomas relacionados. Objetivo: Avaliar os resultados dessa intervenção clínica inicial no seguimento tardio de pacientes recebendo PMg ou placebo. Métodos: Noventa pacientes com ES, sintomáticos e consecutivos foram randomizados (duplo-cego) para receber PMg ou placebo por 30 dias. Visitas mensais de seguimento (15 meses) foram realizadas para avaliar a sintomatologia e controlar eletrólitos. O Holter de 24 horas foi realizado sempre que sintomáticos, ou duas vezes, independentemente dos sintomas. Na segunda fase do estudo, os pacientes cujos sintomas recidivassem, seja do grupo PMg ou placebo (crossing over), receberam PMg seguindo-se o mesmo protocolo. Resultados: Dos 45 pacientes que receberam inicialmente o PMg, 17 (37,8%) apresentaram recidiva dos sintomas em tempo variável nos 15 meses. Os pacientes com recidiva e tratados uma segunda vez apresentaram redução estatisticamente significante na densidade de ES de 138,25/hora (p < 0,001). Os pacientes de crossing reduziram em 247/hora (p < 0,001). Nos pacientes que não apresentaram recidiva, a frequência de ES foi baixa (3 ES/hora). A melhora dos sintomas foi de 76,5% nos retratados e de 71,4% nos de crossing. Conclusão: Houve recorrência de sintomas e das ES em alguns pacientes que usaram PMg, deixando claro não ser essa uma forma de tratamento definitivo ou curativo no seguimento tardio. Contudo, houve também melhora na frequência de ES e de sintomas em uma segunda etapa de tratamento, semelhante à resposta na primeira etapa. .

Correlation analysis of subjective and objective scoring of chronic rhinosinusitis with nasal polyps / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the relationship of of subjective and objective scoring chronic rhinosinusitis with nasal polyps.</p><p><b>METHODS</b>The clinical data of 159 patients with chronic rhinosinusitis were analyzed. SPSS 18.0 software was used to analyze the data. Pearson regression was used to analyze the relationship.</p><p><b>RESULTS</b>The Pearson correlation coefficient r between VAS score (16.380 ± 5.809)and the whole discomfort (5.070 ± 1.361) was 0.710, there were correlation (P < 0.01). The Pearson correlation coefficient r between Lund-Kennedy score (3.724 ± 1.107) and Lund-Mackay score (5.983 ± 2.984) was 0.513, there were correlation (P < 0.01). The Pearson correlation coefficient r between VAS score and Lund-Kennedy score was 0.417, there were correlation (P < 0.05). VAS score had no correlation with Lund-Mackay(r = 0.113, P > 0.05). The whole discomfort had no correlation with Lund-Kennedy score and Lund-Mackay score (r value were 0.309 and 0.022, all P > 0.05).</p><p><b>CONCLUSIONS</b>The subjective and objective score of chronic rhinosinusitis with nasal polyps were contradict sometimes.</p>

Logistic regression analysis on influence factors of chronic sinusitis after endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the clinical effect and the influence factors after endoscopic surgery for chronic sinusitis.</p><p><b>METHODS</b>The clinical data of 337 patients with chronic sinusitis treated by endoscopic surgery were analyzed, including gender, age, culture level, course of the disease, the days of hospitalization, medical history, smoking, drinking, early surgery history, allergic rhinitis (AR) history, clinical classification, visual analogue scale (VAS) score, nasal endoscopy score, nasal polyps, CT examination score, side, nasal adhesion and postoperative follow-up compliance. The clinical effect of endoscopic sinus surgery was evaluated 6 months after operation according to the 1997 Haikou standard. SPSS 18.0 software and conducted chi-square test and logistic regression analysis were used to analyze the data.</p><p><b>RESULTS</b>Three hundred and thirty-seven chronic sinusitis patients were followed up after endoscopic surgery. It was found that 298 cases (88.4%) cured, 29 cases (8.6%) improved, 10 cases (3.0%) invalid. The clinical curative effect of the patients with chronic rhinosinusitis without nasal polyp was better than that of the patients with chronic rhinosinusitis with nasal polyp, the difference was statistically significant (χ(2) = 10.932, P < 0.01). After many factors Logistic regression analysis, the most important effect factor in the clinical curative effect were clinical type, AR or not, VAS score, nasal endoscopic examination score, CT examination score, multiple nasal polyp or not, postoperative nasal adhesion or not and postoperative follow-up compliance.</p><p><b>CONCLUSION</b>The clinical effective of endoscopic sinus surgery is influenced by not only surgery itself, but also by clinical classification, whether and not with AR and so on.</p>

Active neuraminidase constituents of Polygonum cuspidatum against influenza A(H1N1) influenza virus / 中国中药杂志

<p><b>OBJECTIVE</b>To isolate and identify active neuraminidase constituents of Polygonum cuspidatum against influenza A (H1N1) influenza virus.</p><p><b>METHOD</b>On the basis of the bioassay-guided fractionation,such chromatographic methods as silica gel, sephadex LH-20 and HPLC were adopted to isolate active constituents of extracts from Polygonum cuspidatum, and their molecular structures were identifiied on the basis of their spectral data such as NMR and MS and physico-chemical properties.</p><p><b>RESULT</b>Seven compounds were isolated from the ethyl acetate extract of P. cuspidatum and identified as 2-methoxystypandrone (1), emodin (2), resveratrol (3), polydatin (4), emodin-8-O-beta-D-glucopyranoside (5), (E)-3, 5, 12-trihydroxystilbene-3-O-beta-D-glucopyranoside-2'-(3", 4", 5"-trihydroxybenzoate) (6) and catechin-3-O-gallate (7), respectively. Among them, the NA test showed that compounds 3, 6 and 7 had inhibitory effect against NAs activity, with IC50 values of 129.8, 44.8 and 21.3 micromol x L(-1), respectively. Moreover, the further CPE test showed compounds 6 and 7 had significant inhibitory effect against H1N influenza virus (EC50 = 5.9, 0.9 micromol x L(-1), respectively), with very low cytotoxicity to the host cells, their therapeutic selective index(SI) in MDCK cells ranged from 56 to 269.</p><p><b>CONCLUSION</b>The neuraminidase inhibitors against H1N1 anti-influenza virus isolated from extracts of P. cuspidatum on the basis of the bioassay-guided fractionation are significant in specifying their therapeutic material basis and drug R&D against influenza.</p>