Adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit: the contribution of the VIS score and the RACHS-1 / Eventos adversos em pós-operatório cardíaco em uma unidade de terapia intensiva pediátrica: a contribuição do escore VIS e do RACHS-1

ABSTRACT Objective: To evaluate the occurrence of adverse events in the postoperative period of cardiac surgery in a pediatric intensive care unit and to find any patient characteristics that can predict such events. Methods: This was a historical cohort study of patients recovering in the pediatric intensive care unit for the first 7 days after cardiac surgery between April and December 2019, by reviewing the medical records. The following were reviewed: demographic, clinical, and laboratory characteristics; patient severity scores; and selected adverse events, grouped into device-related, surgical, and nonsurgical. Results: A total of 238 medical records were included. At least one adverse event occurred in 110 postoperative patients (46.2%). The total number of adverse events was 193 (81%). Vascular catheters were the most common cause, followed by cardiac arrest, bleeding, and surgical reexploration. In the univariate analysis, the vasoactive-inotropic score (VIS), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, age, Pediatric Index of Mortality (PIM-2), cardiopulmonary bypass and aortic clamping duration were significantly associated with adverse events. In the multivariate analysis, VIS ≥ 20 (OR 2.90; p = 0.004) and RACHS-1 ≥ 3 (OR 2.11; p = 0.019) were significant predictors, while age and delayed sternal closure showed only trends toward significance. To predict the occurrence of adverse events from VIS and RACHS-1, the area under the curve was 0.73 (95%CI 0.66 - 0.79). Conclusion: Adverse events were quite frequent in children after cardiac surgery, especially those related to devices. The VIS and RACHS-1, used together, predicted the occurrence of adverse events well in this pediatric sample.

RESUMO Objetivo: Avaliar a ocorrência de eventos adversos em pós-operatório cardíaco em uma unidade de terapia intensiva pediátrica e estabelecer eventuais associações das características dos pacientes e a possibilidade de predizer tais eventos. Métodos: Coorte histórica de 7 dias de pós-operatório cardíaco, de abril a dezembro de 2019, por revisão de prontuários de pacientes com recuperação em unidade de terapia intensiva pediátrica. Foram revisados: características demográficas e clínico-laboratoriais, escores de gravidade dos pacientes e eventos adversos selecionados agrupados em: relacionados a dispositivos, a aspectos cirúrgicos e a aspectos não cirúrgicos. Resultados: Foram incluídos 238 prontuários. Ocorreu pelo menos um evento adverso em 110 pós-operatórios (46,2 %). O número total de eventos adversos foi 193 (81%), sendo mais frequente a complicação com cateteres vasculares, seguida de parada cardíaca, sangramento e reexploração cirúrgica. Na análise univariada, escore vasoativo-inotrópico (VIS- vasoactive-inotropic score), Risk Adjustment in Congenital Heart Surgery (RACHS-1) score, idade, Pediatric Index of Mortality (PIM-2), tempo de circulação extracorpórea e de clampeamento aórtico foram estatisticamente significantes com eventos adversos. Na análise multivariável, VIS ≥ 20 (OR 2,90; p = 0,004) e RACHS-1 ≥ 3 (OR 2,11; p = 0,019) mostraram-se relevantes e com significância estatística, enquanto idade e fechamento tardio do esterno possuíam apenas tendência a essa associação. Considerando a previsão de ocorrência de eventos adversos a partir dos valores de escore vasoativo-inotrópico e de RACHS-1, a área sob a curva mostrou valor de 0,73 (IC95% 0,66 - 0,79). Conclusão: A frequência de eventos adversos foi expressiva e aqueles relacionados a dispositivos foram os mais frequentes. O VIS e o RACHS-1, utilizados em conjunto, foram capazes de predizer a ocorrência de eventos adversos nesta amostra pediátrica.

COVID-19 y complicaciones cardiovasculares / COVID-19 and cardiovascular complications

RESUMEN Objetivo: Analizar el COVID - 19 y complicaciones cardiovasculares. Método: revisión sistemática. Análisis de los resultados: Una gran proporción de pacientes tiene enfermedad cardiovascular subyacente y factores de riesgo cardíaco. Los factores asociados con la mortalidad incluyen el sexo masculino, la edad avanzada y la presencia de comorbilidades como las enfermedades cardiovasculares. La lesión cardíaca aguda determinada por niveles elevados de troponina de alta sensibilidad se observa comúnmente en casos graves y está fuertemente asociada con la mortalidad, al igual que el síndrome de dificultad respiratoria aguda. Conclusión: La infección por el SARS-CoV-2 presenta una baja mortalidad en la mayoría de los casos, pero un porcentaje significativo de los infectados sufren una enfermedad pulmonar con diferentes grados de afección sistémica que sí conlleva mayor mortalidad. Estos pacientes presentan grados variables de afección miocárdica, tanto directa por el virus como por la situación sistémica grave, que incrementan el riesgo de muerte.

Objective: To analyze COVID-19 and cardiovascular complications. Methods: Systematic review. Analysis of results: A large proportion of patients have underlying cardiovascular disease and cardiac risk factors. Factors associated with mortality include male sex, advanced age and the presence of comorbidities such as cardiovascular disease. Acute cardiac injury as determined by elevated high-sensitivity troponin levels is commonly seen in severe cases and is strongly associated with mortality, as is acute respiratory distress syndrome. Conclusion: SARS-CoV-2 infection has a low mortality in most cases, but a significant percentage of those infected have pulmonary disease with varying degrees of systemic involvement that does lead to increased mortality. These patients have varying degrees of myocardial involvement, both direct from the virus and from the severe systemic situation, which increase the risk of death.

Parámetros Cardiovasculares y su Variación Posterior a una Atención de Urgencia Odontológica

RESUMEN: La atención de urgencia dental se desenvuelve en un contexto de estrés que afecta el comportamiento cardiovascular de los pacientes, expresado como cambios en Frecuencia Cardiaca y Presión Arterial. Se espera que posterior a la atención, estos parámetros varíen conforme se controla el cuadro clínico o se presenten complicaciones. Un estudio observacional retrospectivo recopiló los registros de Frecuencia Cardiaca y Presión Arterial de pacientes atendidos en la urgencia dental del Complejo Asistencial Barros Luco en dos ocasiones, estando la segunda consulta vinculada al primer ingreso, tanto como control post tratamiento o complicaciones derivadas. Datos fueron registrados en Microsoft Excel™ y analizados en SciStat™. 466 pacientes consultaron en dos ocasiones, concentrados entre tercera y quinta década. Los mayores registros de Presión Arterial fueron reportados en controles post atención de Pericoronaritis, infecciones de espacios anatómicos faciales y en complicaciones post tratamiento por Pulpitis, TDA e Infección de espacios anatómicos faciales. En segundas consultas por control de Pulpitis, Alveolitis, TDA, Fracturas faciales y Hemorragias post exodoncia hubo disminución. Frecuencia Cardiaca fue el parámetro con mayor variación existiendo disminución en controles y complicaciones entre consultas. El papel exacto del dolor en la respuesta cardiovascular no está bien delimitado, la interpretación de las investigaciones destinadas a estudiar esto resulta difícil, pues estímulos nociceptivos son sólo uno de los activadores de la respuesta sistémica al estrés. En el postoperatorio el dolor juega un papel importante estudiado a 48 horas, más no, en mediano y largo plazo. Existen variaciones estadísticamente significativas en algunos parámetros estudiados, los cuales pueden presentar significancia clínica a considerar en pacientes hipertensos o cardiópatas. Son necesarios estudios sobre la incidencia particular que tienen los procedimientos odontológicos en la expresión de otros marcadores del estado sistémico.

ABSTRACT: Emergency dental care develops in a context of stress that affects the cardiovascular behavior of patients, expressed as changes in heart rate and blood pressure. After care, these parameters are expected to vary as the clinical picture is controlled or complications occur. A retrospective observational study compiled the heart rate and blood pressure records of patients seen in the dental emergency of the Barros Luco Care Complex on two occasions, the second consultation being linked to the first admission, as well as post-treatment control or derived complications. Data was recorded in Microsoft Excel ™ and analyzed in SciStat ™. 466 patients consulted on two occasions, concentrated between the third and fifth decade. Higher Blood Pressure records were reported in post-care controls for Pericoronitis, infections of facial anatomical spaces and in post-treatment complications due to Pulpitis, ADD and Infection of facial anatomical spaces. In second consultations for control of Pulpitis, Alveolitis, ADT, facial fractures and post- extraction hemorrhages there was a decrease. Heart rate was the parameter with the greatest variation, with a decrease in controls and complications between consultations. The exact role of pain in the cardiovascular response is not well defined, the interpretation of the research aimed at studying this is difficult, since nociceptive stimuli are only one of the activators of the systemic response to stress. In the postoperative period, pain plays an important role, studied at 48 hours, but not in the medium and long term. There are statistically significant variations in some parameters studied which may present clinical significance to be considered in hypertensive or heart disease patients. Studies are needed on the particular incidence that dental procedures have on the expression of other markers of the systemic state.

Single-dose del nido cardioplegia vs. blood cardioplegia in aortic valve replacement surgery

Abstract Introduction: In this study, we aimed to compare Del Nido cardioplegia (DNC) with blood cardioplegia (BC) in aortic valve replacement. Methods: A two-year single-institute retrospective cohort study was accomplished. Subjects who underwent aortic valve replacement surgery were divided into two groups (DNC and BC) and outcomes were compared. Results: Preoperative demographics and clinical data of the patients in both groups were similar. The time until cardiac arrest following administration of the first dose of cardioplegia was statistically significantly shorter in the BC group (47.0 sec. 25-103) than in the DNC group (63.0 sec. 48-140) (P=0.012). Cross-clamping time was longer in the BC group (48.7±12.3 min. vs. 41.5±11.8 min.) (P=0.041). Cardiopulmonary bypass time was statistically significantly shorter in the DNC group (BC 60.8±18.5 min., DNC 53.7±15.2 min.) (P=0.046). The rate of postoperative use of intravenous positive inotropic support drugs (dopamine, dobutamine, norepinephrine, etc.) for more than two hours was significantly higher in the BC group (20 [23.5%] in the BC group and nine [17.3%] in the DNC group) (P=0.035). Creatine kinase myocardial band and troponin I levels were slightly lower in patients receiving DNC, but no statistically significant difference was detected. Conclusion: Del Nido cardioplegia is safe and can be used efficiently as an alternative to blood cardioplegia in isolated aortic valve replacement surgery.

O uso de inibidores do Sistema Renina-Angiotensina pode aumentar a suscetibilidade à infecção pelo SARS-CoV-2 (COVID-19)? / Can the use of Renin-Angiotensin System inhibitors increase the susceptibility to SARSCoV-2 infection (COVID-19)?

Diante do contexto pandêmico da COVID-19, esforços têm sido direcionados ao desenvolvimento de medidas terapêuticas seguras e eficazes no combate à doença. Entretanto, divergências entre as condutas adotadas nesses pacientes tem sido frequentes. Em especial, fármacos inibidores do Sistema Renina-Angiotensina, como os Inibidores da Enzima Conversora de Angiotensina e Bloqueadores do Receptor da Angiotensina, são foco de grande discussão. Diversos autores questionam uma possível relação de risco aumentado entre o uso de tais medicações e o desenvolvimento de formas mais graves da doença, ao correlacionar a regulação positiva da Enzima Conversora de Angiotensina 2 induzida por esses fármacos com o fato do SARS-CoV-2 usar essa enzima como receptor celular. Enquanto isso, outros autores defendem que essa modulação atue como fator protetor à gravidade da infecção, levando em consideração a promoção de efeitos vasodepressores, anti-fibróticos e anti-inflamatórios. Dada a alta prevalência do uso desses anti-hipertensivos, a presente revisão analisa o funcionamento do Sistema Renina-Angiotensina; aspectos moleculares do novo coronavírus; e a inibição da Angiotensina 2 no contexto dessa infecção, para discutir qual conduta seria mais adequada no manejo da hipertensão arterial e doenças cardiovasculares, dada a pandemia da COVID-19.

In the face of the pandemic context of the COVID-19, efforts have been directed to the development of safe and effective therapeutic actions in combating the disease. However, divergences between management of these patients have been frequent. Especially, Renin-Angiotensin System inhibitors, as Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers, are the focus of great discussion. Several authors question a possible increased risk relation between the use of that medication and the development of the most severe disease form, when correlating AngiotensinConverting Enzyme 2 upregulation induced by those drugs with the fact that SARS-CoV-2 uses this enzyme as its cellular receptor. Meanwhile, other authors defend that the referred modulation acts as a protective factor to infection severity, considering the induction of vasodepressor, antifibrotic and anti-inflammatory effects. Given the high prevalence of the use of those antihypertensive drugs, the present review analyses the Renin-Angiotensin System functionning; molecular aspects of the novel coronavirus; and the Angiotensin 2 inhibition in the context of this infection, in order to discuss which conduct would be more appropriate in the management of arterial hypertension and cardiovascular diseases, given the COVID-19 pandemic.

Evolución clínica de niños con shock séptico refractario a fluidos tratados con dopamina o adrenalina. Estudio retrospectivo en un servicio de emergencias pediátrico de Argentina / Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

RESUMEN Objetivo: Analizar la evolución clínica de niños con shock séptico refractario a volumen tratados inicialmente con dopamina o adrenalina. Métodos: Estudio de cohorte retrospectivo con ámbito en un servicio de urgencias pediátrico de un hospital de tercer nivel. Población: niños ingresados con shock séptico refractario a volumen. Se comparó la evolución clínica entre 2 grupos: Grupo Dopamina y Grupo Adrenalina. Las variables de interés fueron: uso de ventilación mecánica invasiva, días de inotrópicos, estancia hospitalaria, estancia en cuidados intensivos y mortalidad. Para variables numéricas y categóricas utilizamos medidas de tendencia central y para comparación las pruebas de U Mann Whitney y χ2 test. Resultados: Incluimos 118 pacientes. El 58,5% recibió dopamina y 41,5% adrenalina. El uso de ventilación mecánica invasiva fue 38,8% para adrenalina versus 40,6% para dopamina (p = 0,84) con una mediana de 4 días para adrenalina y 5,5 para dopamina (p = 0,104). La mediana para días de inotrópicos fue de 2 días para ambos grupos (p = 0,714). La mediana de estancia hospitalaria fue de 11 para adrenalina y 13 para dopamina (p = 0,554) y de estancia en cuidados intensivos se registró una mediana de 4 días (0 - 81 días) siendo igual en ambos grupos (p = 0,748). La mortalidad fue de 5% para el Grupo Adrenalina versus 9% para el Grupo Dopamina (p = 0,64). Conclusiones: En nuestro centro, no observamos diferencias en uso de ventilación mecánica invasiva y tiempo de inotrópicos, estancia hospitalaria y cuidados intensivos y mortalidad entre niños ingresados al servicio de urgencias pediátrico con diagnóstico de shock séptico refractario a volumen tratados inicialmente con dopamina o adrenalina.

Abstract Objective: To analyze the clinical outcome of children with fluid-refractory septic shock initially treated with dopamine or epinephrine. Methods: A retrospective cohort study was conducted at a pediatric emergency department of a tertiary hospital. Population: children admitted because of fluid-refractory septic shock. Clinical outcome was compared between two groups: Dopamine and Epinephrine. Variables evaluated were use of invasive mechanical ventilation, days of inotropic therapy, length of hospital stay, intensive care stay, and mortality. For numerical and categorical variables, we used measures of central tendency. They were compared by the Mann-Whitney U-test and the (2 test. Results: We included 118 patients. A total of 58.5% received dopamine and 41.5% received epinephrine. The rate of invasive mechanical ventilation was 38.8% for epinephrine versus 40.6% for dopamine (p = 0.84), with a median of 4 days for the Epinephrine Group and 5.5 for the Dopamine Group (p = 0.104). Median time of inotropic therapy was 2 days for both groups (p = 0.714). Median hospital stay was 11 and 13 days for the Epinephrine and Dopamine groups, respectively (p = 0.554), and median stay in intensive care was 4 days (0 - 81 days) in both groups (p = 0.748). Mortality was 5% for the Epinephrine Group versus 9% for the Dopamine Group (p = 0.64). Conclusions: At our center, no differences in use of invasive mechanical ventilation, time of inotropic therapy, length of hospital stay, length of intensive care unit stay, or mortality were observed in children admitted to the pediatric emergency department with a diagnosis of fluid-refractory septic shock initially treated with dopamine versus epinephrine.

Performance verification of a time-of-flight mass spectrometry based cardiovascular drug-related polygene detection system / 中华检验医学杂志

Objective@#Toestablish and verify the method of genetic polymorphisms using time-of-flight mass spectrometry as a polygene testing platform.@*Methods@#998 cases of DNA samples and 20 cases of whole blood samples were collected from Fuwai hospital of Chinese academy of medical sciencesduring September 2017 to October 2018, including 512 cases of males and 506 cases of females.280 patients aged 18-30, 442 patients aged 31-64, and 296 patients aged ≥65.11 cardiovascular drugsrelatedgenes in 998 DNA samples were detected by time-of-flight mass spectrometry to evaluate the compliance rate compared with identifiedresults. 20whole blood samples were selected to detect 11 genes using both time-of-flight mass spectrometry and Sanger sequencing. The results were compared twice, and accuracy was evaluated according to Sanger sequencing as the gold standard. Ten cases of genomic DNA with wild-type loci were selected for specific evaluation by time-of-flight mass spectrometry. Samples containing all heterozygous genotypes were measured after gradient dilution to evaluate the detection sensitivity of the new method. Samples containing all 49 genotypes (two genotypes were not found because they are rare in Chinese population) were used in order to do the inter-assay and intra-assay precision evaluation. An anti-interference study was performed by selecting wild and homozygous mutant samples of represented heterozygous peak shape.@*Results@#The results showed that the compliancerate of the single retrospective sample was over 99.5%. The resultsof time-of-flight mass spectrometry and Sanger sequencing was the same. The minimum detection limit of DNA was 0.4 ng, the inter-assay and intra-assay precision were 100%, and the degradation ability of the UNG enzyme was 105 copies/μl in aerosol.The reaction system has a strong anti-interference ability to the genome and intermediate aerosol, and no cross-contamination between different matrices of the chip.@*Conclusions@#The time-of-flight mass spectrometry as a polygene detection system shows agood detection performance and can be applied to clinical detection. In addition, this paper established a performance verification research scheme based on the time-of-flight mass spectrometry platform polygene detection system.

Influences of Xinnaoning capsules on aorta calcium sensing receptor of rats with myocardial infarction and endothelial protection mechanisms based on the theory of phlegm and blood stasis / 中国医师杂志

Objective@#To observe the impacts of Xinnaoning capsules on the aortic intimal structure, serum levels of diponectin (APN) and calcium sensing receptor (CaSR) expression in rats with myocardial infarction, and explore the endothelial protection mechanisms of Xinnaoning.@*Methods@#15 male Sprague Dawley (SD) rats in sham operation group were randomly selected from 60 rats, the rest 45 rats were fed with high fat diet for 6 weeks and received coronary artery ligation operation. The successful modeling rats were randomly divided into model group, western medicine group and traditional Chinese medicine(TCM) group, and fed with high fat diet for 8 weeks. The sham operation group fed with normal diet. The western medicine group and TCM group received atorvastatin and Xinnaoning capsules, respectively; the sham operation group and model group received same amount of distilled water. After treatment of 4 weeks, the aortic intimal structure was observed by hematoxylin-eosin (HE); the serum levels of triacylglycerol (TG), total cholesterol (TC), low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured by microplate test; serum levels of APN and CaSR expression were determined by enzyme linked immunosorbent assay (ELISA) and Western blot, respectively.@*Results@#Compared with sham operation group, aortic intimal structure derangement and plaque formation in intima in model group, and serum levels of TG, TC, LDL and CaSR expression were increased; HDL and APN were decreased (P<0.05). Compared with model group, the endarterium was more smooth in the western medicine group and TCM group, serum levels of TG, TC, LDL and CaSR expression were decreased; HDL and APN were increased (P<0.05). And there were no significant differences between western medicine group and TCM group (P>0.05).@*Conclusions@#Xinnaoning capsules are effective for myocardial infarction.

Influences of Xinnaoning capsules on aorta calcium sensing receptor of rats with myocardial infarction and endothelial protection mechanisms based on the theory of phlegm and blood stasis / 中国医师杂志

Objective To observe the impacts of Xinnaoning capsules on the aortic intimal structure,serum levels of diponectin (APN) and calcium sensing receptor (CaSR) expression in rats with myocardial infarction,and explore the endothelial protection mechanisms of Xinnaoning.Methods 15 male Sprague Dawley (SD) rats in sham operation group were randomly selected from 60 rats,the rest 45 rats were fed with high fat diet for 6 weeks and received coronary artery ligation operation.The successful modeling rats were randomly divided into model group,western medicine group and traditional Chinese medicine (TCM) group,and fed with high fat diet for 8 weeks.The sham operation group fed with normal diet.The western medicine group and TCM group received atorvastatin and Xinnaoning capsules,respectively;the sham operation group and model group received same amount of distilled water.After treatment of 4 weeks,the aortic intimal structure was observed by hematoxylin-eosin (HE);the serum levels of triacylglycerol (TG),total cholesterol (TC),low density lipoprotein (LDL) and high density lipoprotein (HDL) were measured by microplate test;serum levels of APN and CaSR expression were determined by enzyme linked immunosorbent assay (ELISA) and Western blot,respectively.Results Compared with sham operation group,aortic intimal structure derangement and plaque formation in intima in model group,and serum levels of TG,TC,LDL and CaSR expression were increased;HDL and APN were decreased (P ＜ 0.05).Compared with model group,the endarterium was more smooth in the western medicine group and TCM group,serum levels of TG,TC,LDL and CaSR expression were decreased;HDL and APN were increased (P ＜0.05).And there were no significant differences between western medicine group and TCM group (P ＞0.05).Conclusions Xinnaoning capsules are effective for myocardial infarction.

Analysis of Cardiovascular Medication Use in Dementia Patients

OBJECTIVE: Dementia is one of important social and economic healthcare issues in the aging age. Therefore, it signifies to analyze the relationship between chronic disease or cardiovascular drug use and the incidence of dementia to establish a basis for increasing or preventing the risk of dementia. The purpose of this study was to investigate the correlation between the prevalence of chronic diseases and the use of cardiovascular drugs in patients diagnosed with dementia. METHODS: In this study, we used data from sample of elderly patients from the Health Insurance Review and Assessment Service. We analyzed by logistic regression analysis with age, gender, and medication as covariates. KCD-7 was used to diagnosis of the disease, and drugs were analyzed using ATC codes and Korean standardized drug classification codes. RESULTS: A total of 1,276,331 patients were analyzed in the sample of the elderly population, of which 532,075 (41.7%) were male and 744,256 (58.3%) were female. The patients have the higher risk of dementia in the older, women, and lower socioeconomically status. Cerebral infarction and ischemic heart disease increases risk of dementia. Patients taking statins, angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor antagonists (ARB) showed low incidence of dementia. CONCLUSION: This study has been shown that ACEI, ARB, and statin drugs may associate with lower incidence of Alzheimer's and other dementia except vascular dementia.

Nuevos enfoques farmacológicos en el manejo de la angina de pecho estable / New pharmacological approaches in the management of stable angina

RESUMEN En años recientes han sido introducidos nuevos antianginosos al mercado con mecanismos de acción novedosos, complementarios a los del arsenal farmacoterapéutico existente. Aunque el tratamiento de primera línea continúan siendo los betabloqueadores, antagonistas de canales de calcio y nitratos, el descubrimientos de nuevos aspectos fisiopatológicos de la enfermedad permitieron el desarrollo de blancos terapéuticos innovadores a nivel celular y molecular. El nicorandil, la trimetazidina, la ivabradina y la ranolazina se consideran nuevos fármacos antianginosos y constituyen la segunda línea de tratamiento de la angina de pecho estable; están indicados en pacientes que persisten sintomáticos a pesar del manejo de primera línea o en aquellos que presentan intolerancia o contraindicación a los betabloqueadores o antagonistas de canales de calcio. La trimetazidina, a través de su mecanismo de acción metabólico, mejora la tolerancia al ejercicio y puede ser útil en pacientes con falla cardíaca y contraindicación al uso de digitales; la ivabradina tiene un efecto cronotrópico negativo sin afectar el inotropismo ni la tensión arterial por lo que se puede usar en pacientes con taquiarritmias o falla cardíaca concomitante; en contraste, la ranolazina no afecta el cronotropismo por lo que se usa en pacientes con bradiarritmias aunque puede generar prolongación del intervalo QTc. La elección de alguno de estos medicamentos antianginosos de primera o segunda línea debe ser individualizado para cada paciente y se basa en las comorbilidades, contraindicaciones y preferencias del paciente. MÉD.UIS. 2016;29(3):79-93.

ABSTRACT In recent years, new antianginal agents with novel mechanisms of action have been launched to the market, as a complement to the existing therapeutic arsenal. Even though the beta-blockers, calcium channel blockers and nitrates continue to be the first line of treatment, recent discoveries of pathophysiological aspects of the disease led to the development of innovative therapeutic targets on both cellular and molecular level. Nicorandil, trimetazidine, ivabradine and ranolazine are novel antianginal drugs and constitute the second line of treatment of stable angina; these drugs are indicated for those patients who persist symptomatic despite treatment with first line agents or in those with contraindication or intolerance to beta-blockers o calcium channel blockers. Trimetazidine, through its metabolic mechanism of action, improves exercise tolerance and might be useful in patients with concomitant heart failure and contraindication to digitalis; ivabradine can be used in patients with concomitant tachyarrhythmias due to its negative chronotropic effect without affecting inotropism or blood pressure; in contrast, ranolazine doesn't affect chronotropism and can be used in patients with bradyarrhythmias, however, it might cause prolongation of the QTc interval. The choice of treatment with either of the first line or second line antianginal agents must be individualized for each patient and based on comorbidities, contraindications and patient's preference. MÉD.UIS. 2016;29(3):79-93.

Effect of long-acting nitrate on expression of Ang Ⅱ receptor subtypes in kidneys of heart failure rats / 中华老年心脑血管病杂志

Objective To study the effect of long‐acting nitrate on cardiac function and expression of AngⅡreceptor (ATR)subtypes in kidneys of chronic heart failure (CHF)rats after myocardial infarction .Methods Ninety male Wistar rats aged 10 weeks were randomly divided into control group (group A ,n=9) ,sham operation group (group B ,n=8) ,HF model group (group C ,n=9) , low Elantan dose group (group D ,n=9) ,high Elantan dose group (group E ,n=9) ,olmesartan group (group F ,n=9) ,and combined high Elantan dose and olmesartan group (group G ,n=8) .A HF model was established by ligating the left anterior descending artery .The animals received gastric drugs for 6 weeks .Their cardiac function was assyed by ultrasound echocardiography and expressions of AT1 R and AT2 R were detected by RT‐PCR and Western blot ,respectively .Results The PRA and AngⅡexpression levels were significantly higher ,the AT1 R expression level was significantly higher and the AT2 R expression level was significantly lower in group C than in group B (P<0 .01 ,P<0 .05) .The PRA and AngⅡexpression levels were significantly lower ,the AT1 R expression level was significantly lower and the AT2 R expression level was significantly higher in groups E‐G than in group C (P<0 .05 ,P<0 .01) .The receptor expression levels were much higher in group G than in group F (P<0 .05) .Conclusion Long‐term use of long‐acting nitrate can effectively improve cardiac function and protect renal function .

Effect of Yixintai granule on myocardial remodeling in rabbits with chronic heart failure / 中国医师杂志

Objective To explore the effect of Yixintai granule on myocardial remodeling in rabbits with chronic heart failure ( CHF) .Methods The rabbit model of CHF with adriamycin was established. These successful CHF models of rabbits were divided into model group, high,middle, and low dose of Yix-intai groups, losartan potassium group, and normal control group.Echocardiographic indexes and myocardi-al remodeling indexes were measured after 4 weeks of medication.Results Compared to the model group, the left ventricular posterior wall (LVPW), left ventricular internal diameter at end-systole (LVIDs), left ventricular internal diameter at end-diastole ( LVIDd) , cardiac index ( CI) , and left ventricular mass index (LVWI) of the treatment groups were decreased ( P <0.05 or P <0.01), and the interventricular septum ( IVS) of the middle and high Yixintai groups was decreased significantly ( P <0.01 ) .Compared to the low dose of Yixintai group, the IVS, LVPW, CI, and LVWI of the middle and high Yixintai groups were decreased ( P <0.05 or P <0.01) , and the LVIDs and LVIDd of the high Yixintai group were decreased ( P <0.05 ) .Conclusions Yixintai granule can improve myocardial remodeling in rabbits with CHF. Meanwhile, the curative effect of medial and high groups of Yixintai is better than the low dose group.

Applications and mechanism of some clinical common medications used as anti-cancer therapy sensitizer / 国际肿瘤学杂志

A number of medications have been proved to be able to either improve the antitumor effect of chemotherapeutics and molecular targeted drugs or reverse the resistance of tumors to chemotherapeutics and molecular targeted drugs,which are not traditionally used as anticancer drugs.Especially for late-stage tumors after multiple treatments,these agents are good alternatives when used independently or in combination with chemotherapeutics and molecular targeted drugs.These drugs include proton modulators,hypoglycemic agents and cardiovascular agents,etc.

Management of patients with heart failure / Manuseio do paciente portador de insuficiência cardíaca

The treatment of heart failure (HF) has advanced greatly in recent decades. Today, based on evidence, it includes beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and spironolactone. For symptomatic patients, we must add a diuretic and/or digitalis. For these medications to be effective they must be used in full doses. The objective of this study was the correct treatment modifies the natural history of the disease, reducing its morbidity and mortality. To check its effectiveness, symptoms reduction, reversal of, increase of ejection fraction and reduction of heart rate are assessed. When there is no improvement of these characteristics, or the treatment is inadequate and must be improved, or the clinical picture is very serious, there is a poor prognosis. Early detection of HF allows measures to be taken in order to modify the natural history of the disease. Thus, we should encourage the correct treatment since early stages of the disease, preventing progression to advanced and refractory forms.

O tratamento da insuficiência cardíaca (IC) avançou muito nas últimas décadas. Hoje, baseado em evidências inclui o uso de betabloqueadores, inibidores da enzima conversora de angiotensina,bloqueadores do receptor da angiotensina II e espironolactona.Para os pacientes sintomáticos devem-se acrescentar um diurético e/ou digital. Para que esses fármacos sejam efetivos devem ser empregados em doses plenas. O objetivo deste estudo foi observar o tratamento correto modifica a história natural da doença, reduzindo sua morbidade e mortalidade. Para verificar sua efetividade,avalia-se a melhora dos sintomas, reversão da dilatação cardíaca,aumento da fração de ejeção e redução da frequência cardíaca.Quando não há melhora destas características, ou o tratamento é insuficiente e deve ser melhorado ou que o quadro clínico é muito grave e o paciente terá, então, um prognóstico sombrio. A detecção precoce da insuficiência cardíaca permite que medidas sejam tomadas a fim de modificar a história natural da doença.Deve-se, portanto encorajar o tratamento correto desde os estágios iniciais da doença, prevenindo a progressão para formas avançadas e refratárias.

Hipertensión Arterial Resistente / Resistant hypertension

Se define a la hipertensión resistente como la presión arterial que se mantiene por encima de los niveles establecidos a pesar de estar usándose tres medicamentos antihipertensivos en dosis óptimas; y una de estas tres drogas debiera ser un diurético. Los pacientes cuya presión arterial se mantiene controlada pero que requieran 4 o más medicamentos también son considerados como resistentes al tratamiento. Los análisis realizados en estudios a gran escala de medicamentos antihipertensivos apuntan a una prevalencia de 10 a 20% para la hipertensión resistente al tratamiento en la población general de hipertensos. Los pacientes con hipertensión resistente tienen una probabilidad de 50% o más de experimentar un evento adverso cardiovascular en comparación con aquellos con hipertensión controlada que están usando tres o menos agentes antihipertensivos. Los estudios indican que un 5 a un 10% de los pacientes con hipertensión resistente tienen una causa secundaria subyacente para su presión arterial elevada, una prevalencia significativamente mayor comparada con lo observado en la población general de hipertensos. La mejor evidencia disponible sustenta el empleo de espironolactona en dosis bajas como el cuarto medicamento antihipertensivo preferible si los niveles séricos de potasio de los pacientes estuvieran bajos. Si tales valores fueran más elevados, deberá considerarse una intensificación de una terapia con diuréticos del grupo de las tiazidas. La terapia de denervación simpática renal, siendo una intervención invasiva, potencialmente podría estimular un cambio de paradigmas en el manejo de la hipertensión resistente.

Resistant hypertension is defined as blood pressure that remains above target in spite of using three optimally dosed antihypertensive drugs of different classes, and one of the three drugs should be a diuretic. Patients whose blood pressure is controlled but requiring 4 or more drugs are also considered as resistant to treatment. Analyses of large scale trials of antihypertensive drugs point to a 10-20% prevalence of resistant hypertension in the general hypertensive population. Patients with resistant hypertension are almost 50% more likely to experience an adverse cardiovascular event compared with those with controlled blood pressure using three or less antihypertensive agents. Studies indicate that 5-10% of patients with resistant hypertension have an underlying secondary cause for their elevated blood pressure - a prevalence significantly greater compared to that of the general hypertensive population. The best available evidence supports the use of low dose spironolactone as the preferred fourth antihypertensive drug if the patient's blood potassium level is low. With higher blood potassium levels, intensification of thiazide-like diuretic therapy should be considered. Renal sympathetic denervation therapy, as a device based intervention, could potentially stimulate a paradigm shift in the management of resistant hypertension.

The effects of Tong Xin-Luo on human umbilical vein endothelial cells impaired by lysophosphatidylcholine / 中国医师杂志

Objective To investigate the effects of Tong Xin-Luo on cultured human umbilical vein endothelial cells (HUVECs) impaired by Lysophosphatidylcholine.Methods The herbage-contained serum of TXL was prepared,HUVECs were cultured in vitro.The study was designated to 4 group:normal control,LPC group,TXL group,and TXL + LPC intervened group.The cell function was determined by cell morphology and MTT colorimetric assay.Results Compaired with normal control group (0.380 ±0.023 ),LPC ( 0.320 ± 0.024 ) could significantly decrease the cells activity,promote cells death ( P ＜0.05 ).After TXL intervened(0.424 ±0.034),cells activity was significantly increased,cells death was d significantly decreased( P ＜0.05 ).Conclusions Tong Xin-Luo could protect human umbilical vein endothelial cells function by against the LPC-induced damage.

Analysis of clinical features of 426 patients with acute myocardial infarction / 中国基层医药

Objective To analyze clinical characteristics, hospital treatment, complications and mortality differences of the patients with acute myocardial infarction (AMI) by conventional treatment. Methods Retrospective analysis of 426 cases of AMI patients, aged 20-103 years [mean age(67. 82 ±0. 56) years] ,male 261 cases,female 165 cases, the general condition of patients were recorded, history features, diagnosis, treatment, complications and prognosis. Comparison of elderly(≥70 years) and non-elderly(＜70 years) ,male and female patients with clinical features, treatment, complications and mortality differences. Results Compared with the non-elderly patients with AMI,elderly patients had significantly lower smoking history(P＜0.05) ,female ratio,history of old myocardial infarction rate, cardiac function≥Killip Ⅲ level was significantly higher(all P＜0.05). During hospitalization in patients of different ages diuretics,β blockers, digitalis, clopidogrel and other drugs, application of a significant difference (all P＜0.05). Elderly AMI patients with complete left bundle branch block,atrioventricular block,atrial fibrillation,the incidence was higher than non-elderly patients (all P＜0.05) ,but no difference in mortality between the two groups (P＞0.05). Female patients than male patients with age of onset was significantly (P＜0.05) , and the smoking rate is low,but clearly the high rate of angina died(P＜0.05) ,sub-poor cardiac function after myocardial infarction(P＜0.05). Application of cardiac drugs in addition to nutrition than men,female patients, the rate of other conventional therapy,no difference in both complications and prognosis(all P＞0.05). Conclusion AMI was the major diseases threatening human life,different age had its own clinical characteristics of patients,and it could not be impacted by gender.

Drug Interactions between Cardiovascular Agents and Psychotropic Drugs / 정신신체의학

There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.

Cardiovascular and hematologic effects produced by chronic treatment with etoricoxib in normotensive rats / Efeitos cardiovasculares e hematológicos produzidos pelo tratamento crônico com etoricoxib em ratos normotensos

PURPOSE: Evaluate the cardiovascular and hematological effects produced by chronic treatment with two dosis of etoricoxib in Wistar normotensive rats. METHODS: Thirty rats have been used and divided into one control group and two etoricoxib (10mg/kg and 30mg/kg) treatments groups for 60 days. The mean arterial pressure (MAP) was taken during the whole experimental period and at the end of this period, under anesthesia blood samples were taken, and further the withdrawn of the aorta, heart, brain, liver, and kidneys for the anatomopathologic study. RESULTS: The treatment with etoricoxib (30mg/Kg) produced a significant increase of the MAP from the 28th day of the experiment and from the platelets when compared to the control group and to the group treated with 10mg/Kg, besides producing a highly significant difference in hematocrit and in the red blood cells in relation to the control group. On the other hand the treatment with etoricoxib has not caused histopathological changes when compared to the control. CONCLUSION: These data show that the chronic treatment with etoricoxib leads to increase of the MAP, and to important hematological changes which seem to be associated to the hemoconcentration although not producing anatomopathological significant changes.

OBJETIVO: Avaliar os efeitos cardiovasculares e hematológicos produzidos pelo tratamento crônico com duas doses de etoricoxib em ratos Wistar normotensos. MÉTODOS: Foram utilizados 30 ratos divididos em um grupo controle e dois grupos tratamentos (10mg/kg e 30mg/kg) de etoricoxib por 60 dias. A pressão arterial média (PAM) dos animais foi aferida durante todo o período experimental e, ao final deste, sob anestesia, foram coletadas amostras de sangue, além da retirada da aorta, coração, cérebro, fígado e rins para estudo anatomopatológico. RESULTADOS: O tratamento com etoricoxib (30mg/Kg) produziu aumento significativo da PAM a partir do 28° dia do experimento e das plaquetas quando comparado ao grupo controle e ao grupo tratado com etoricoxib 10 mg/Kg, além de produzir diferença altamente significativa no hematócrito e nas hemácias em relação ao grupo controle. Por outro lado, o tratamento com etoricoxib, não produziu alterações histopatológicas quando comparado ao controle. CONCLUSÃO: Estes dados indicam que o tratamento crônico com etoricoxib produz aumento da PAM, além de importantes alterações hematológicas que parecem estar associadas à hemoconcentração, porém sem produzir alterações anatomopatológicas significativas.