Effect of Low-Dose Nebivolol in Patients with Acute Myocardial Infarction: A Multi-Center Observational Study / 전남의대학술지

The optimal dose of beta blockers after acute myocardial infarction (MI) remains uncertain. We evaluated the effectiveness of low-dose nebivolol, a beta1 blocker and a vasodilator, in patients with acute MI. A total of 625 patients with acute MI from 14 teaching hospitals in Korea were divided into 2 groups according to the dose of nebivolol (nebistol®, Elyson Pharmaceutical Co., Ltd., Seoul, Korea): low-dose group (1.25 mg daily, n=219) and usual- to high-dose group (≥2.5 mg daily, n=406). The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, composite of death from any cause, non-fatal MI, stroke, repeat revascularization, rehospitalization for unstable angina or heart failure) at 12 months. After adjustment using inverse probability of treatment weighting, the rates of MACCE were not different between the low-dose and the usual- to high-dose groups (2.8% and 3.1%, respectively; hazard ratio: 0.92, 95% confidence interval: 0.38 to 2.24, p=0.860). The low-dose nebivolol group showed higher rates of MI than the usual- to high-dose group (1.2% and 0%, p=0.008). The 2 groups had similar rates of death from any cause (1.1% and 0.3%, p=0.273), stroke (0.4% and 1.1%, p=0.384), repeat PCI (1.2% and 0.8%, p=0.428), rehospitalization for unstable angina (1.2% and 1.0%, p=0.743) and for heart failure (0.6% and 0.7%, p=0.832). In patients with acute MI, the rates of MACCE for low-dose and usual- to high-dose nebivolol were not significantly different at 12-month follow-up.

Carvedilol as primary prophylaxis for gastric variceal bleeding in portal hypertension model in rats / Carvedilol como profilaxia de sangramento em varizes gástricas em modelo de hipertensão portal em ratos

ABSTRACT Background: Portal hypertension (PH) can be measured indirectly through a hepatic vein pressure gradient greater than 5 mmHg. Cirrhosis is the leading cause for PH and can present as complications ascites, hepatic dysfunction, renal dysfunction, and esophagogastric varices, characterizing gastropathy. Aim: To evaluate the use of carvedilol as primary prophylaxis in the development of collateral circulation in rats submitted to the partial portal vein ligament (PPVL) model. Method: This is a combined qualitative and quantitative experimental study in which 32 Wistar rats were divided into four groups (8 animals in each): group I - cirrhosis + carvedilol (PPVL + C); group II - cirrhosis + vehicle (PPVL); group III - control + carvedilol (SO-sham-operated + C); group IV - control + vehicle (SO-sham-operated). After seven days of the surgical procedure (PPVL or sham), carvedilol (10 mg/kg) or vehicle (1 mL normal saline) were administered to the respective groups daily for seven days. Results: The histological analysis showed no hepatic alteration in any group and a decrease in edema and vasodilatation in the PPVL + C group. The laboratory evaluation of liver function did not show a statistically significant change between the groups. Conclusion: Carvedilol was shown to have a positive effect on gastric varices without significant adverse effects.

RESUMO Racional: A hipertensão portal (HP), medida indiretamente através do gradiente pressórico da veia hepática >5 mmHg, tem como principal causa etiológica a cirrose. Possui como complicações a ascite, disfunção hepática, disfunção renal e varizes esofagogástricas, que caracterizam o quadro de gastropatia. Objetivo: Avaliar o uso do carvedilol como profilaxia primária no desenvolvimento da circulação colateral em ratos submetidos ao modelo de ligadura parcial de veia porta (LPVP). Método: Estudo experimental qualitativo e quantitativo no qual foram utilizados 32 ratos Wistar, divididos em quatro grupos (n=8): grupo I - cirrose + carvedilol (LPVP+C); grupo II - cirrose + veículo (LPVP); grupo III - controle + carvedilol (SO - sham-operated+C); grupo IV - controle + veículo (SO - sham-operated). Após transcorridos sete dias do procedimento cirúrgico, foi administrado carvedilol (10 mg/kg) e veículo (1mL) para os respectivos grupos por sete dias consecutivos. Resultados: A análise histológica não mostrou alteração hepática em nenhum grupo e diminuição de edema e vasodilatação no grupo LPVP+C. A avaliação laboratorial da função hepática não mostrou alteração com significância estatística entre os grupos. Conclusão: Carvedilol mostrou ser fármaco com efeito positivo no sangramento das varizes gástricas e sem efeitos adversos significantes.

Beta-adrenergic signaling on neuroendocrine differentiation, angiogenesis, and metastasis in prostate cancer progression / 亚洲男科学杂志(英文版)

Prostate cancer is a complex, heterogeneous disease that mainly affects the older male population with a high-mortality rate. The mechanisms underlying prostate cancer progression are still incompletely understood. Beta-adrenergic signaling has been shown to regulate multiple cellular processes as a mediator of chronic stress. Recently, beta-adrenergic signaling has been reported to affect the development of aggressive prostate cancer by regulating neuroendocrine differentiation, angiogenesis, and metastasis. Here, we briefly summarize and discuss recent advances in these areas and their implications in prostate cancer therapeutics. We aim to provide a better understanding of the contribution of beta-adrenergic signaling to the progression of aggressive prostate cancer.

A step-up ractopamine feeding program for finishing pigs / Niveles incrementales de ractopamina para cerdos en ceba / Plano de níveis aumentados de ractopamina para suínos em terminação

Abstract Background: Ractopamine (RAC) supplementation in the feed has been evaluated as a strategy to increase productive efficiency in finishing pigs. Objective: To evaluate the effects of different RAC dietary levels on performance, carcass traits, efficiency of lysine (ELU) and energy (EEU) utilization, and economic viability in finishing pig. Methods: A total of 40 barrows (74.75 ± 5.22 kg) were fed four RAC levels (0, 5, 10 and 5-10 mg/kg step-up program) from 0-14, 15-31 and 0-31 days. Performance, carcass characteristics, ELU, EEU, cost per unit of weight gain (CWG), payment and profit parameters were measured. The animals were distributed in a completely randomized design in four treatments, with ten replicates per treatment. The experimental unit was each animal. Results: Pigs fed RAC diets showed increased body weights at 14 and 31 days, average daily gain (ADG) at 0-14 and 0-31 days, ELU at 0-14 days, and hot carcass weight as compared with those fed the control diet. The step-up program as compared to the 10 mg/kg RAC concentration resulted in increased body weight, feed/gain ratio (FGR), ADG, ELU, EEU and CWG at 0-14 days. Payment by weight and bonus payment were better for treatments with RAC as compared to control. Conclusions: Pigs fed RAC improved performance, carcass weight, ELU, EEU and economic viability. The results were better for the step-up program compared with the intermittent use of 10 mg/kg RAC.

Resumen Antecedentes: La suplementación de cerdos con ractopamina (RAC) es una estrategia para aumentar la eficiencia productiva en ceba. Objetivo: Evaluar el efecto de diferentes planes de suplementación con RAC en dietas de cerdos en ceba sobre el rendimiento productivo, características de la canal, eficiencia de utilización de lisina (ELU) y energía (EEU), y viabilidad económica. Métodos: Un total de 40 machos castrados (74,75 ± 5,22 kg) fueron alimentados con cuatro niveles de RAC (0, 5, 10 y 5-10 mg/kg de plano escalonado) de 0-14, 15-31 y 0-31 días. Se evaluó el rendimiento, características de la canal, ELU, EEU, el costo por unidad de ganancia de peso (CWG), los tipos de pago y ganancias. Los animales se distribuyeron en un diseño completamente aleatorizado en cuatro tratamientos, con diez repeticiones por tratamiento. La unidad experimental fue cada animal. Resultados: Los animales suplementados con RAC tuvieron mayor peso corporal a los 14 y 31 días, ganancia de peso diaria (ADG) de 0-14 y 0-31 días, ELU de 0-14 días y peso de la canal caliente en comparación con el grupo control. En comparación con la concentración de 10 mg/kg de RAC, el plano escalonado resultó en un aumento de peso corporal, conversión alimenticia (FGR), ADG, ELU, EEU y CWG a los 0-14 días. El pago por peso y el pago por bonificación fueron mejores para los tratamientos con RAC en comparación con el control. Conclusiones: Los cerdos en ceba alimentados con RAC tienen mejor rendimiento, peso de la canal, ELU, EEU y viabilidad económica. Los resultados de los parámetros estudiados son mejores con el uso del plano escalonado en comparación con el uso continuo de 10 mg/kg de RAC.

Resumo Antecedentes: Suplementação de ractopamina (RAC) em dietas para suínos foi avaliada como uma estratégia para aumentar eficiência de produção de suínos em terminação. Objetivo: Avaliar os efeitos de diferentes planos de suplementação de RAC em dietas para suínos em terminação sobre o desempenho, características de carcaça, eficiência de utilização de lisina (ELU) e energia (EEU), e viabilidade econômica. Métodos: Um total de 40 machos castrados (74.75 ± 5.22 kg) foram alimentados com quatro níveis de RAC (0, 5, 10 e 5-10 mg/kg plano escalonado) em 0-14, 15-31 e 0-31 dias. Desempenho, características de carcaça, ELU, EEU, custo por unidade de ganho de peso (CWG), tipos de pagamento e lucro foram mensurados. Os animais foram distribuídos em um delineamento inteiramente casualizado em quatro tratamentos, dez repetições para cada tratamento. A unidade experimental foi cada animal. Resultados: Os animais alimentados com dietas contendo RAC mostraram aumento de peso corporal aos 14 e 31 dias, ganho de peso diário (ADG) de 0-14 e 0-31 dias, ELU de 0-14 dias e peso de carcaça quente comparado ao grupo controle. O plano escalonado comparado ao nível de 10 mg/kg de RAC mostrou maior peso corporal, conversão alimentar (FGR), ADG, ELU, EEU e CWG de 0-14 dias. Pagamento por peso e pagamento por bonificação foram melhor para tratamentos com RAC em comparação ao controle. Conclusões: Suínos alimentados com RAC mostram melhor desempenho, peso de carcaça, ELU, EEU e viabilidade econômica. Os resultados dos parâmetros estudados foram melhores com uso do plano escalonado quando comparado com uso constante de 10 mg/kg de RAC para suínos em terminação.

Use of ractopamine during compensatory gain of finishing pigs on carcass and meat performance and quality / Uso de ractopamina durante ganho compensatório de suínos em terminação sobre o desempenho e a qualidade da carcaça e de carne

The objective of this study was to evaluate the effects of compensatory gain associated with the use of 10ppm ractopamine after a period of feed restriction in finishing pigs on performance, carcass and meat quality. Twenty castrated males and 20 females, at 110 days of age and 66.137±6.13kg live weight, were submitted to four treatments using a 2 x 2 factorial design (fed ad libitum or with 20% restriction between 0(21 days of age and fed with or without 10ppm ractopamine for 22(42 days of experimentation), with 10 replicates (animals). There was no interaction between the factors for any of the evaluated parameters. Animals treated with ractopamine presented better weight gain (1.083 versus 1.259kg), feed conversion (2.910 versus 2.577), warm and cold carcass weight (86.08 versus 89.00 and 83.46 versus 87.20kg, respectively), loin depth (63.02 versus 68.40mm), loin eye area (41.43 versus 46.59mm2) and muscle fiber diameter (27.48 versus 35.85µm). Animals submitted to feed restriction followed by ad libitum feed presented compensatory gain without losses to carcass and meat characteristics, but with a reduction in the ethereal extract (2.19 versus 1.64%) and lower water loss due to thawing in the meat (11.35 versus 9.42%). The effects of compensatory gain after food restriction and ractopamine are independent of the parameters evaluated.(AU)

Objetivou-se avaliar os efeitos do ganho compensatório associado ao uso de 10ppm de ractopamina após um período de restrição alimentar, em suínos em terminação, sobre características de desempenho, carcaça e qualidade de carne. Foram utilizados 20 machos castrados e 20 fêmeas, com 110 dias de idade e 66,137±6,13kg de peso vivo, submetidos a quatro tratamentos, fatorial 2 x 2 (alimentação à vontade ou com 20% de restrição entre zero e 21 dias de experimentação; e alimentação à vontade, sem ou com 10ppm de ractopamina, durante 22 a 42 dias de experimentação), com 10 repetições, sendo o animal a repetição. Não houve interação entre os fatores para nenhum dos parâmetros avaliados. Animais tratados com ractopamina apresentaram melhor ganho de peso (1,083 versus 1,259kg), conversão alimentar (2,910 versus 2,577), peso da carcaça quente e fria (86,08 versus 89,00 e 83,46 versus 87,20kg, respectivamente), profundidade do lombo (63,02 versus 68,40mm), área de olho de lombo (41,43 versus 46,59mm2) e diâmetro de fibras musculares (27,48 versus 35,85µm). Animais submetidos à restrição alimentar seguida de arraçoamento ad libitum apresentaram ganho compensatório sem prejuízos às características de carcaça e à carne, mas com redução do extrato etéreo (2,19 versus 1,64%) e menor perda de água por descongelamento na carne (11,35 versus 9,42%) Os efeitos do ganho compensatório após a restrição alimentar e da ractopamina mostram-se independentes sobre os parâmetros avaliados.(AU)

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Síndrome coronario agudo con supradesnivel del ST asociado al feocromocitoma con las catecolaminas inicialmente normales / Acute coronary syndrome with ST elevation associated with pheochromocytoma with initially normal catecholamine values

Los feocromocitomas son tumores secretores de catecolaminas que cursan con paroxismos de hipertensión o hipotensión arterial y palpitaciones. Son una causa rara del síndrome coronario agudo. Presentamos el caso de una paciente con síndrome coronario agudo secundario a feocromocitoma que inicialmente tenía valores normales de catecolaminas.

Pheochromocytomas are catecholamine-secreting tumors that involve paroxysmal hypertension or hypotension and palpitations. They are a rare cause of acute coronary syndrome. We present the case of a patient with acute coronary syndrome secondary to a pheochromocytoma with initially normal catecholamine values.

The Intoxication of Beta Blocker with Psychiatric Drugs Focused on the Cardiovascular Adverse Effects

PURPOSE: Beta blocker (BB) has been prescribed for anxiety and panic disorder. Patients intoxicated by psychiatric drugs have often been exposed to BB. Moreover, BB overdose has adverse effects including cardiovascular effects, which can be life-threatening. This study was conducted to identify the characteristics of BB intoxication with psychiatric drugs and the adverse effects on the cardiovascular system. METHODS: A single center, retrospective study was performed from January 2010 to December 2015. A total of 4,192 patients visited the emergency department (ED) with intoxication, and 69 with BB intoxication were enrolled. RESULTS: Overall, 64 patients (92.8%) of enrolled patients were intoxicated with drugs prescribed for the purpose of psychiatric disorders. Propranolol was the most common BB (62 cases, 96.2%), and the median dose was 140.0 mg (25%-75% 80.0-260.0). Twenty-four patients (37.5%) had experienced cardiovascular events, and these patients tended to have decreased mentality, hypotension and coingestion with quetiapine. An initial mean arterial pressure (MAP) below 65 mmHg (odds ratio 10.069, 95% confidence interval 1.572-64.481, p=0.015) was identified as a factor of cardiovascular event upon multiple logistic regression analysis. CONCLUSION: Initial MAP below 65 mmHg was a factor of cardiovascular adverse effect in patients of BB intoxication with psychiatric drugs.

Influence of preoperative propranolol on cardiac index during the anhepatic phase of liver transplantation / Influência do propranolol pré-operatório no índice cardíaco durante a fase anepática do transplante hepático / Influencia del propranolol preoperatorio en el índice cardíaco durante la fase anhepática del trasplante hepático

INTRODUCTION: Liver transplantation is the best therapeutic option for end-stage liver disease. Non-selective beta-blocker medications such as propranolol act directly on the cardiovascular system and are often used in the prevention of gastrointestinal bleeding resulting from HP. The effects of propranolol on cardiovascular system of cirrhotic patients during liver transplantation are not known. OBJECTIVE: Evaluate the influence of propranolol used preoperatively on cardiac index during the anhepatic phase of liver transplantation. METHOD: 101 adult patients (73 male [72.2%]) who underwent cadaveric donor orthotopic liver transplantation by piggyback technique with preservation of the retrohepatic inferior vena cava performed at Hospital das Clinicas, Federal University of Minas Gerais were evaluated. There was no difference in severity between groups by the MELD system, p = 0.70. The preoperative use of propranolol and the cardiac index outcome were compared during the anhepatic phase of liver transplantation in 5 groups (I: increased cardiac index, II: cardiac index reduction lower than 16%, III: cardiac index reduction equal to or greater than 16% and less than 31%, IV: cardiac index reduction equal to or greater than 31% and less than 46%, V: cardiac index reduction equal to or greater than 46%). RESULTS: Patients in group I (46.4%) who received propranolol preoperatively were statistically similar to groups II (60%), III (72.7%), IV (50%) and V (30.8%), p = 0.57. CONCLUSION: The use of propranolol before transplantation as prophylaxis for gastrointestinal bleeding may be considered safe, as it was not associated with worsening of cardiac index in anhepatic phase of liver transplantation. .

INTRODUÇÃO: O transplante hepático (TH) é a melhor opção terapêutica para doença hepática em estágio terminal (DHET). As medicações betabloqueadoras não seletivas, como o propranolol, atuam diretamente no sistema cardiovascular (SCV) e são frequentemente usadas na prevenção de hemorragia digestiva decorrente da HP. Os efeitos do propranolol no SCV de cirróticos durante o TH não são conhecidos. OBJETIVO: Avaliar a influência do uso pré-operatório do propranolol no índice cardíaco (IC) durante a fase anepática do TH. MÉTODO: Avaliaram-se 101 pacientes adultos (73 homens, 72,2%) submetidos a transplante ortotópico de fígado doador cadáver, pela técnica de piggyback com preservação da veia cava inferior retro-hepática, feito no Hospital das Clínicas da Universidade Federal de Minas Gerais. Não houve diferença de gravidade pelo sistema MELD entre os grupos, p = 0,70. Foram comparados o uso pré-operatório de propranolol com o desfecho do IC durante a fase anepática do TH em cinco grupos (I: aumento do IC; II: redução do IC inferior a 16%; III: redução do IC igual a ou maior do que 16% e menor do que 31%; IV: redução do IC igual a ou maior do que 31% e menor do que 46%;V: redução do IC igual a ou maior do que 46%). RESULTADOS: Pacientes que fizeram uso pré-operatório de propranolol no grupo I (46,4%) foram estatisticamente semelhantes aos dos grupos II (60%), III (72,7%), IV (50%) e V (30,8%), p = 0,57. CONCLUSÃO: O propranolol no pré-transplante, como profilaxia para hemorragia digestiva, pode ser considerado seguro, pois não se associou à pioria do IC na fase anepática do TH. .

INTRODUCCIÓN: El trasplante hepático (TH) es la mejor opción terapéutica para la enfermedad hepática en estado terminal. Los betabloqueantes no selectivos, como el propranolol, actúan directamente en el sistema cardiovascular y a menudo son usadas en la prevención de la hemorragia digestiva proveniente de la hipertensión portal. Los efectos del propranolol en el sistema cardiovascular de cirróticos durante el TH no se conocen. OBJETIVO: Evaluar la influencia del uso preoperatorio del propranolol en el índice cardíaco (IC) durante la fase anhepática del TH. MÉTODO: Se estudiaron 101 pacientes adultos (73 hombres [72,2%]) sometidos a trasplante ortotópico de hígado de donante cadáver, por la técnica de piggyback con preservación de la vena cava inferior retrohepática, en el Hospital das Clínicas de la Universidad Federal de Minas Gerais. No hubo diferencia respecto a la gravedad por el sistema Meld entre los grupos (p = 0,70). Se comparó el uso preoperatorio del propranolol con el resultado del IC durante la fase anhepática del TH en 5 grupos (i: aumento del IC; ii: reducción del IC < 16%; iii: reducción del IC ≥ 16% y < 31%; iv: reducción del IC ≥ 31% y < 46%;v: reducción del IC ≥ 46%). RESULTADOS: El número de pacientes que usaron el propranolol en el preoperatorio en el grupo i (46,4%) fue estadísticamente similar a los grupos ii (60%), iii (72,7%), iv (50%) y v (30,8%), p = 0,57. CONCLUSIÓN: El propranolol en el pretrasplante, como profilaxis para la hemorragia digestiva, puede ser considerado seguro porque no se asoció con el empeoramiento del IC en la fase anhepática del TH. .

Atenolol prevents the formation of expansive hematoma after rhytidoplasty / O atenolol previne a formação de hematoma expansivo após ritidoplastia

Objective: To evaluate the perioperative use of atenolol in reducing the incidence of hematoma after rhytidoplasty. Methods: Between January 2007 and February 2013, 80 patients were randomized into two groups: Group A (n = 26) received perioperative atenolol in order to maintain heart rate (PR) around 60 per minute; Group B (n = 54) did not receive atenolol. Both groups underwent the same anesthetic and surgical technique. We monitored blood pressure (BP), HR, hematoma formation and the need for drainage. Patients were followed-up until the 90th postoperative day. The variables were compared between the groups using the ANOVA test. Continuous variables were presented as mean ± standard deviation and the differences were compared with the Student's t test. Values of p d" 0.05 were considered significant. Results: In group A the mean BP (110-70mmHg ± 7.07) and HR (64 / min ± 5) were lower (p d" 0.05) than in group B (135-90mmHg ± 10.6) and (76 / min ± 7.5), respectively. There were four cases of expansive hematoma in group B, all requiring reoperation for drainage, and none in group A (p d" 0,001). Conclusion: The perioperative use of atenolol caused a decrease in blood pressure and heart rate and decreased the incidence of expanding hematoma after rhytidectomy. .

Objetivo: avaliar o uso perioperatório do atenolol na redução da incidência de hematoma pós-ritidoplastia. Métodos: entre janeiro de 2007 e fevereiro de 2013 foram randomizados 80 pacientes em dois grupos: Grupo A (n=26) recebeu atenolol perioperatório com objetivo de manter frequência de pulso (FP) ± 60 por minuto, Grupo B (n=54) não recebeu atenolol. Ambos os grupos foram submetidos à mesma técnica anestésico-cirúrgica. A pressão arterial (PA) e FP, formação de hematoma e a necessidade de drenagem foram monitorizados. Houve seguimento até o 90º dia de pós-operatório. As variáveis foram analisadas entre os dois grupos utilizando-se o teste de ANOVA. As variáveis contínuas foram apresentadas como média (± Desvio-padrão) e as diferenças foram comparadas utilizando-se o t de Student. Foram considerados significantes os valores p<0,05. Resultados: as médias no grupo A de PA (110-70mmHg ± 7,07) e FP (64 /min ± 5) foram menores (p<0,05) em relação ao grupo B (135-90mmHg ± 10,6) e (76/min ± 7,5), respectivamente. Houve quatro casos de hematoma expansivo no grupo B, todos com necessidade de reoperação para a sua drenagem e nenhum no grupo A (p<0,001). Conclusão: o uso do atenolol perioperatório promoveu a redução de pressão arterial e frequência de pulso e diminuiu a incidência de hematoma expansivo pós-ritidoplastia. .

Betabloqueio com atenolol não reduz potência aeróbia nem muda limiares ventilatórios em hipertensos sedentários / Atenolol beta-block does not decrease aerobic power or alter ventilatory thresholds in sedentary hypertensive subjects

INTRODUÇÃO: O exercício aeróbio é recomendado para o tratamento da hipertensão. Sua intensidade pode ser prescrita com base na porcentagem da frequência cardíaca máxima (%FCmáx) ou no consumo pico de oxigênio (%VO2pico) em que os limiares ventilatórios (LV) são alcançados. Entretanto, alguns hipertensos que iniciam o treinamento podem estar tomando betabloqueadores, o que pode influenciar esses parâmetros. OBJETIVO: verificar os efeitos do atenolol sobre os LV de hipertensos sedentários. MÉTODOS: Nove voluntários realizaram dois testes ergoespirométricos máximos após quatro semanas de tratamento com atenolol (25 mg administrado por via oral duas vezes por dia) e com placebo, administrados em ordem fixa e de forma cega. Durante os testes, a frequência cardíaca (FC), a pressão arterial (PA) e o VO2 no repouso, limiar anaeróbio (LA), ponto de compensação respiratória (PCR) e pico do esforço foram analisados. RESULTADOS: O VO2 aumentou progressivamente no exercício e seus valores foram semelhantes nos dois tratamentos. A PA sistólica e a FC também aumentaram no exercício, mas seus valores absolutos foram significativamente menores com o atenolol. Porém, o aumento da PA sistólica e da FC no exercício foi semelhante com os dois tratamentos. Assim, o percentual da FCmáx e o percentual do VO2pico em que LA e PCR foram alcançados não diferiram entre o placebo e o atenolol. CONCLUSÃO: O atenolol na dosagem de 50 mg/dia não afetou o percentual do VO2pico e da FCmáx em que os LV são atingidos, o que confirma que a prescrição de intensidade de treinamento com base nessas porcentagens pode ser mantida em hipertensos que recebem betabloqueadores.

INTRODUCTION: Aerobic exercise is recommended for the treatment of hypertension. Its intensity can be prescribed based on the percentage of maximum heart rate (% MHR) or peak oxygen consumption (VO2peak%) in which the ventilatory thresholds (VT) are achieved. However, some hypertensive patients who begin aerobic training may be receiving beta-blockers, which can influence these parameters. OBJECTIVE: To investigate the effects of atenolol on VT of sedentary hypertensive patients. METHODS: Nine volunteers performed two cardiopulmonary exercise tests until exhaustion after 4 weeks of treatment with atenolol (25 mg orally twice daily) and with placebo, administered in a fixed order and in a blinded manner. During the tests, heart rate (HR), blood pressure (BP), VO2 at rest, anaerobic threshold (AT), respiratory compensation point (RCP) and peak effort were analyzed. RESULTS: VO2 increased progressively throughout the exercise and the values were similar for both treatments. Systolic blood pressure and heart rate also increased progressively during the exercise, but their absolute values were significantly lower with atenolol. However, the increase in systolic BP and HR during exercise was similar in both treatments. Thus, the % of MHR and %VO2peak at which LA and PCR were achieved were not different between placebo and atenolol. CONCLUSION: Atenolol, at a dosage of 50mg/day, did not affect the % of VO2peak and % of MHR corresponding to the VTs, which confirms that prescription of training intensity based on these percentages is adequate to hypertensive patients receiving beta-blockers.

Assessment of Bronchodilator Responsiveness Following Methacholine-Induced Bronchoconstriction in Children With Asthma

PURPOSE: The aim of this study was to investigate bronchodilator responsiveness (BDR) following methacholine-induced bronchoconstriction and to determine differences in BDR according to clinical parameters in children with asthma. METHODS: The methacholine challenge test was performed in 145 children with mild to moderate asthma, and the provocative concentration causing a 20% decline in FEV1 (PC20) was determined. Immediately after the challenge test, patients were asked to inhale short-acting beta2-agonists (SABAs) to achieve BDR, which was assessed as the change in FEV1% predictedx100/post-methacholine FEV1% predicted. For each subject, the asthma medication, blood eosinophil count, serum total IgE, serum eosinophil cationic protein level, and skin prick test result were assessed. RESULTS: The FEV1 (mean+/-SD) values of the 145 patients were 90.5+/-10.9% predicted, 64.2+/-11.5% predicted, and 86.2+/-11.2% predicted before and after methacholine inhalation, and following the administration of a SABA, respectively. The BDR did not differ significantly according to asthma medication, age, or gender. However, BDR in the atopy group (37.4+/-17.7%) was significantly higher than that in the non-atopy group (30.5+/-10.7%; P=0.037). Patients with blood eosinophilia (38.6+/-18.1%) displayed increased BDR compared with patients without eosinophilia (32.0+/-13.8%; P=0.037). CONCLUSIONS: In children with mild to moderate asthma, the responsiveness to short-acting bronchodilators after methacholine-induced bronchoconstriction was not related to asthma medication, but was higher in children with atopy and/or peripheral blood eosinophilia.

Effects on electrical restitution of given esmolol during cardiopulmonary resuscitation in a swine ventricular fibrillation model / 中华急诊医学杂志

Objective To investigate the effect on electrical restitution of β1-adrenergic receptor antagonist esmolol administered during cardiopulmonary resuscitation in the porcine ventricular fibrillation model. Method Ventricular fibrillation untreated for four minutes was induced by dynamic steady state pacing protocol in 40 healthy male pigs, in which local unipolar electrograms were recorded using one 10-electrode catheter that was sutured to the left ventrieular epicarditan. During CPR, animals were randomized into two groups to receive saline as placebo or esmolol after two standards doses of epinephrine. At postresuscitation 2-hour, six pigs were randomly selected from each group and the second VF induction was performed. Local activation-recovery intervals (ARI) restitutions and the VF inducibility between control group and esmolol group were compared. Western blotting was performed to determine cardiac ryanodine receptor (RyR2) protein expression, and their phosphorylation status. Results No sig-nificant differences were observed at the restoration of spontaneous circulation between two groups. Higher postre-suseitation 2-hour survival rate was observed in the esmolol group. Esmolol significantly flattened ARI restitution slope, lessened regional difference of ARI restitution, decreased the VF inducibility, and alleviated RyR2 hyper-phosphorylation. Conclusions Esmolol given during CPR significantly improved postresuscitation 2-hour survival rate. Its effects on modulating electrical restitution property and intracellular calcium handling make up the most important reasons why β1-blockade significantly reduced the onset and maintenance of VF.

Infarto perioperatorio en cirugía no-cardíaca y dexmedetomidina / Perioperative myocardical infaction in non-cardiac surgery and dexmedetomidine

La patología cardiovascular es la primera causa de muerte en Chile y en el mundo. Desde el punto de vista quirúrgico, anestesiólogos y cirujanos enfrentan más frecuentemente pacientes mayores con patología cardiovascular. La incidencia de isquemia miocárdica en pacientes de alto riesgo, sometidos a cirugía no-cardíaca, es cercana al 40 por ciento durante el perioperatorio. La incidencia de infarto miocárdico y muerte en cirugía no-cardíaca, oscila entre 1 y 5 por ciento. Existe una estrecha relación entre los eventos isquémicos perioperatorios y el aumento de la morbimortalidad cardiovascular. Por este motivo, se han desarrollado medidas terapéuticas orientadas a disminuir la incidencia de isquemia perioperatoria y aminorar el daño asociado a ella. La adecuada identificación de pacientes de riesgo, la optimización del tratamiento médico de patologías asociadas y el uso de fármacos cardioprotectores durante el perioperatorio, han mostrado disminuir la incidencia de complicaciones cardíacas. Dexmedetomidina es un agonista beta2-adrenérgico de uso frecuente en anestesia. La evidencia sugiere que posee propiedades cardioprotectoras que podrían beneficiar a pacientes quirúrgicos de alto riesgo cardiovascular. La cardioprotección conferida por dexmedetomidina estaría mediada por la modulación del sistema nervioso autónomo. La disminución de la frecuencia cardíaca y de la presión arterial observada durante su uso, evitarían el desbalance entre aporte y demanda de oxígeno miocárdico y atenuarían el estrés sobre placas ateromatosas inestables. Hasta este momento se desconoce si dexmedetomidina produce precondicionamiento cardíaco y si activa vías transduccionales asociadas a cardioprotección. Frente a la actual realidad epidemiológica en Chile y el mundo, es importante estudiar y definir, cuales son los fármacos de uso frecuente en anestesia con capacidad cardloprotectora y los mecanismos Involucrados en esta protección. Sería Interesante lograr...

Cardiovascular disease is the leading cause of death In Chile and worldwide. Anesthesiologists and surgeons often face more elderly surgical patients with cardiovascular disease. The incidence of myocardial Ischemia in patents at high risk, undergoing non-cardiac surgery is about 40 percent during the perioperative period. The incidence of myocardial Infarction and death in non-cardiac surgery is between 1 and 5 percent. There is a close relationship between perioperative Ischemic events and increased cardiovascular morbidity and mortality Therefore, therapeutic approaches have been developed to reduce the Incidence of perioperative Ischemia and lessen the damage associated with it. The proper Identification of patients at risk, optimizing the medical treatment of associated diseases and the use of cardioprotective drugs during the perioperative period have shown to decrease the Incidence of cardiac complications. The beta2-adrenergic agonist dexmedetomidine is commonly used in anesthesia. The evidence suggests that possesses cardioprotective properties that could benefit surgical patients at high cardiovascular risk. The cardioprotection conferred by dexmedetomidine would be mediated by modulation of the autonomic nervous system. The decrease in heart rate and blood pressure observed during its use could avoid the Imbalance between supply and myocardial oxygen demand and lessen the stress on unstable athermanous plaques. So far it is unknown whether dexmedetomidine produces cardiac preconditioning by activating cardioprotective-signaling pathways. Faced with the current worldwide epidemiologic situation, It would be Important to study the cardioprotective capacity of drugs frequently used in anesthesia and the mechanisms Involved In that protection. It would be interesting to achieve that definition regarding the perioperative use of dexmedetomidine.

Effect of Korean Red Ginseng on Stress Responses and beta-Adrenergic Receptor Function in a Normal Population / 대한정신약물학회지

OBJECTIVE : There have been few studies to examine the effect of Korean red-ginseng on autonomic nervous system. The aim of this study is to examine the effect of Korean red-ginseng on beta-adrenergic receptor function in a normal population. METHODS : Thirty four healthy normal subjects who were 20-40 years old were recruited for the study. They were randomized into the two groups ; red-ginseng group (n=19) and placebo group (n=15). Three gram of red-ginseng or placebo per day was administered to the study subjects for 3 weeks. Before and after the medications, we measured the lymphocyte beta-adrenergic receptor function (Bmax, cAMP, and Kd), and psychological scales such as the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), and Spielberger State and Trait Anxiety Inventory (STAI). This study was a double-blind, placebo-controlled, randomized, comparative study. RESULTS : There were no significant differences in the changes of beta-adrenergic receptor density (Bmax) and sensitivity (cAMP) and psychological assessments between the two groups according to the medications. However, we found significant (group x time) effects for Kd, and beta-adrenergic receptor affinity (1/Kd) was increased significantly in the Korean red-ginseng group. CONCLUSION : In a normal population, Korean red-ginseng showed a potential effects on the beta-adrenergic receptor function, which may play an important role in the regulation of stress responses

Effect of Korean Red Ginseng on Stress Responses and beta-Adrenergic Receptor Function in a Normal Population / 대한정신약물학회지

OBJECTIVE : There have been few studies to examine the effect of Korean red-ginseng on autonomic nervous system. The aim of this study is to examine the effect of Korean red-ginseng on beta-adrenergic receptor function in a normal population. METHODS : Thirty four healthy normal subjects who were 20-40 years old were recruited for the study. They were randomized into the two groups ; red-ginseng group (n=19) and placebo group (n=15). Three gram of red-ginseng or placebo per day was administered to the study subjects for 3 weeks. Before and after the medications, we measured the lymphocyte beta-adrenergic receptor function (Bmax, cAMP, and Kd), and psychological scales such as the Stress Response Inventory (SRI), Beck Depression Inventory (BDI), and Spielberger State and Trait Anxiety Inventory (STAI). This study was a double-blind, placebo-controlled, randomized, comparative study. RESULTS : There were no significant differences in the changes of beta-adrenergic receptor density (Bmax) and sensitivity (cAMP) and psychological assessments between the two groups according to the medications. However, we found significant (group x time) effects for Kd, and beta-adrenergic receptor affinity (1/Kd) was increased significantly in the Korean red-ginseng group. CONCLUSION : In a normal population, Korean red-ginseng showed a potential effects on the beta-adrenergic receptor function, which may play an important role in the regulation of stress responses

Consideration of Features of beta-blocker Medication after Acute Myocardial Infarction in the Emergency Department

PURPOSE: To assess factors that influcence beta-blocker use in ST-segment elevation myocaridal infarction (STEMI) in the emergency department (ED) and to identify features related to beta-blocker use. METHODS: A retrospective study was conducted of STEMI ED patients presenting to tertiary hospital ED from January 2005 to December 2006. Two hundred eighty-seven patients were enrolled. Chi2 analysis was used to assess beta-blocker usage. RESULTS: Two hundreds eighty-seven patients were identified. Total patients eligible for beta-blocker were 241 (84%). Of these, 234 (97%) received a beta-blocker in the ED. Two hundreds twelve patients (73.9%) were male and, 166 patients (57.8%) were over sixty years of age. Eligibility of patients for beta-blocker was not different by gender or age. Only 39 (13.6%) did not take beta-blocker. Although 46 patients had contraindications. Seven patients eligible for beta-blocker did not take the drug and there were inadvertent medications of 14. We categorized all patients receiving beta-blocker into three groups; early, normal, and delayed drug administration. Of 248 patients, 148 (59.6%) were early, 50 (20.2%) were normal, 50 (20.2%) were delayed. There were no differences in the three groups by gender (p=0.869). Only 22 patients received beta-blockers from emergency physicians (EP). All inadvertents medications were administered by internists. CONCLUSION: Several articles have reported underutilization of beta-blocker according to age and gender. In the present study, however, there appears to be no age or gender difference suggesting improvement in practices with beta-blocker. Of concern, though, is the large number of patients (50) who received drug only after more than twelve hours (door to drug time) in the ER. This indicates that although practices of medication were improved in the ER, adequacy and appropriateness of medication is not good. Therefore, an education program for beta-blocker use should be directed towards early medication (especially within two hours). In addition, beta-blocker administration by EPs should be emphasized because of their close early contact with patients.

The Advance of Diagnosis and Therapy on Elderly Patients with Coexistence of COPD and CHF / 中国慢性病预防与控制

The prevalence of obstructive pulmonary disease (COPD) and chronic heart failure (CHF) increased gradually with age. The coexistence of COPD and CHF was very common but often neglected. To avoid overlooking COPD in patients with known CHF, pulmonary function tests should be routinely obtained. Likewise, to avoid overlooking CHF in patients with known COPD, left ventricular function should be routinely assessed. Plasma brain natriuretic peptide was a useful index to differentiate COPD exacerbation from CHF decompensation in patients presenting with acute dyspnea. Skeletal muscle metabolic alterations and its atrophy were the common mechanisms which resulting in deterioration of function capacity in elderly patients with CHF and COPD. Contrary to the conventional belief, long-term beta adrenergic blockers should be given to elderly patients with CHF and COPD. Exercise training reverses rapidly progress of skeletal muscle metabolic alterations and atrophy and promotes independence and life quality in elderly patients.

Pulmonary Edema following Phenylephrine Intranasal Spray Administration during the Induction of General Anesthesia in a Child

Topical phenylephrine, an agent used to facilitate nasotracheal intubation and prevent nasal mucosal bleeding, can cause severe hypertension in some patients, secondary to its stimulation of alpha-adrenergic receptors. Moreover, a high incidence of pulmonary edema is found in patients whose phenylephrine administration is followed by treatment with beta-blocking agents. We report a case of acute pulmonary edema in a pediatric patient who developed severe hypertension after the inadvertent administration of a large dose of topical nasal phenylephrine, followed by beta-adrenergic antagonists (esmolol).