单纯非体外循环冠状动脉旁路移植术后新发房颤 术前相关危险因素分析

目的 探讨单纯非体外循环下冠状动脉旁路移植术（CABG）患者术后新发房颤（POAF）发生的术前相关 危险因素。方法 单纯非体外循环下CABG患者1 888例,根据POAF定义分为新发房颤组（POAF组,389例）与未发 房颤组（NPOAF组,1 499例）。单因素分析2组患者一般临床资料、术前生化指标、术前心脏超声、冠状动脉病变及术 前用药情况,对差异有统计学意义的指标进一步行Logistics回归分析。结果 POAF发生率为20.60%（389/1 888）, POAF组年龄、慢性阻塞性肺疾病（COPD）病史和心肌梗病史比例、术前尿素氮（BUN）水平、左心房内径（LAD）、左室 舒张末期内径（LVEDD）均高于NPOAF组,术前心功能HYHA分级劣于NPOAF组（P＜0.05）;POAF组患者术前应用 β受体阻滞剂比例明显低于NPOAF组（P＜0.01）;Logistic回归分析结果显示,高龄与LAD增大是发生POAF的术前 独立危险因素,术前应用β受体阻滞剂是POAF发生的保护因素。结论 年龄、LAD及术前β受体阻滞剂应用与单纯 非体外循环下CABG患者POAF发生有一定相关性。     

血浆心房利钠肽水平与房颤电复律后窦性心律维持的关系

目的　探讨血浆ANP水平与持续房颤转律术后窦性心律维持的关系。方法　62例持续房颤患者转律前检测血浆ANP水平,转律成功后随访12±2月分为房颤(AF)组和窦性心律(SR)组。结果　血浆ANP水平>40pg/ml者SR维持率97%,Logistic回归分析显示血浆ANP水平与AF持续时间是转律后SR维持的独立影响因子。联合血浆ANP水平和AF持续时间预测转律效果有较高的特异性、精确性和阳性预测值。结论 血浆ANP水平高或AF持续时间短者转律后SR较易维持,反之则SR不易维持。     

经皮冠状动脉介入术术后病人 CYP2C19*2、CYP2C19*3和 PON1基因多态性与氯吡格雷血药浓度及疗效的相关性分析

目的探讨经皮冠状动脉介入术( PCI)术后病人 CYP2C19*2、CYP2C19*3及 PON1基因多态性与氯吡格雷血药浓度及疗效的相关性。方法采用定时定量焦磷酸测序技术检测 CYP2C19*2、CYP2C19*3及 PON1基因型。使用反相高效液相色谱法(RP?HPLC)法,以艾司唑仑为内标,测定氯吡格雷、羧酸氯吡格雷( SR26334)血药浓度。结果共纳入 51例 PCI术后病人,果显示 CYP2C19快代谢型血药浓度( 1.09±0.61)μg/mL与慢代谢型 SR26334血药浓度( 1.54±0.48)μg/mL之间差异有统计学意结义( P＝0.038 9)PON1(126C>G)野生型( CC型)病人 SR26334血药浓度( 1.45±0.63)μg/mL与突变型( CG+GG型)病人 SR26334血药浓度( 1.09±0.3,2)μg/mL差异有统计学意义( P＝0.0408)。 SR26334峰浓度与终点事件相关性分析中可见,正常组病人血药浓度( 1.51±0.48)μg/mL VS心血管事件组病人血药浓度( 1.06±0.65)μg/mL差异有统计学意义( P＝0.0481)CYP2C19基因型与终点事件的发生无明显相关。结论基因检测和血药浓度检测可为 ACS病人 PCI术后个体化抗血小板治疗,方案的制订提供依据,可作为临床药师开展药学服务的切入点之一。     

血浆正五聚蛋白3、血清降钙素原水平对重度脑外伤病人呼吸机相关性肺炎的早期诊断价值

目的探讨血浆正五聚蛋白3(PTX3)水平对重度脑外伤病人呼吸机相关性肺炎的早期诊断价值。方法选取2017年9月至2018年10月在哈尔滨医科大学附属第一医院神经重症监护室,接受呼吸机机械通气治疗的重度脑外伤病人108例,其中将52例发生呼吸机相关性肺炎病人作为观察组,56例未发生呼吸机相关性肺炎病人作为对照组。两组病人于呼吸机辅助通气前和结束辅助通气后48 h内测定血浆PTX3、血清降钙素原水平及监测心率变化,并采用临床肺部感染评分(CPIS)评估病人肺部感染症状。Pearson相关性分析检验病人PTX3、降钙素原、心率水平与CPIS评分关系。采用Cox回归分析探索重度脑外伤病人呼吸机相关性肺炎的影响因素。ROC曲线分析PTX3、降钙素原水平对呼吸机相关性肺炎早期诊断的临床价值。结果在机械通气撤机后,与对照组比较,观察组病人PTX3［(436.45±106.76)μg/L比(312.28±64.81)μg/L］、降钙素原、心率、CPIS水平明显升高(P<0.05)。PTX3、降钙素原、心率水平均与CPIS评分均呈正相关(P<0.05)。PTX3、降钙素原高表达是重度脑外伤病人呼吸机相关性肺炎的独立危险因素(P<0.05)。血浆PTX3水平诊断重度脑外伤病人呼吸机相关性肺炎的曲线下面积(AUC)为0.961,截断值为404.004 μg/L,灵敏度和特异度分别为71.2%、88.5%;降钙素原水平诊断时AUC为0.813,截断值为0.764 μg/L,灵敏度和特异度分别为88.5%、87.6%;二者联合诊断时AUC为0.992,灵敏度和特异度分别为92.5%、90.7%。结论PTX3、降钙素原异常表达与重度脑外伤病人呼吸机相关性肺炎发生有密切关系,且血浆PTX3单独或与血清降钙素原联合对重度脑外伤病人呼吸机相关性肺炎均有一定诊断价值,可为临床早期诊断提供一定参考。     

心房颤动患者血浆D-二聚体、C反应蛋白水平与左心房内径的相关性

目的 探讨心房颤动（AF）患者血浆D-二聚体（D-dimer）、C反应蛋白（CRP）水平与左心房内径（LAD）的关系.方法 选择AF患者53例,窦性心律（SR）者32例.各AF亚组的D-dimer、CRP及LAD相互比较,并分别与SR组比较.结果 AF组的D-dimer、CRP、LAD水平高于SR组;持续性和永久性AF组的D-dimer、CRP水平高于SR组、阵发性AF组;持续性AF组的LAD大于SR组;永久性AF组LAD亦高于阵发性AF组、SR组;以上差异均有统计学意义（均P＜0.05）.AF组的D-dimer、CRP与LAD之间均存在直线相关性（r=0.376、0.33,P＜0.05）.结论 CRP的升高与心房颤动的持续时间有关;LAD与高凝状态、炎性反应呈正相关.     

Notch1与核转录因子-κB在腹主动脉瘤血浆中的表达

目的 探讨腹主动脉瘤(AAA)血浆中Notch1、核转录因子-κB(NF-κB)的表达水平及意义。方法 选取2012年1月至2018年1月南阳市中心医院收治的84例AAA病人作为AAA组,选取同期入院的性别、年龄相匹配的非AAA病人50例作为对照组,比较两组血浆Notch1、NF-κB浓度,采用受试者操作曲线(ROC)评价血浆Notch1和NF-κB诊断AAA的价值。结果 AAA组肾下腹主动脉最大径为32~87(59.67±5.92) mm,对照组为18~25(22.16±3.64) mm,两组比较,差异有统计学意义(P＜0.05);AAA组血浆Notch1(182.26±20.13)pg/mL、NF-κB(132.16±13.36)ng/L显著高于对照组［(102.64±15.31) pg/mL、(34.17±5.73) ng/L］,差异有统计学意义(P＜0.05);不同肾下腹主动脉直径的AAA病人血浆Notch1、NF-κB水平比较,差异无统计学意义(P＞0.05);Pearson相关分析显示,血浆Notch1、NF-κB与AAA病人肾下腹主动脉直径无明显相关性(r＝0.164,P＞0.05),血浆Notch1与血浆NF-κB水平呈正相关关系(r＝0.561,P＜0.05);血浆Notch1联合NF-κB诊断AAA的特异性96.0%高于血浆Notch1、NF-κB单独诊断的特异性80.0%、76.0%,差异有统计学意义(P＜0.016)。结论 AAA病人伴随血浆Notch1、NF-κB浓度升高,血浆Notch1联合NF-κB诊断AAA的效能优于单独检测。     

冠状动脉旁路移植术后早期心房颤动的相关因素分析

目的分析冠状动脉旁路移植（CABG）术后早期心房颤动（AF）发生的相关因素,为探讨其相应的防治措施提供依据。方法回顾性总结2002年3月至2007年10月间住院手术治疗的单纯CABG病例101例,按术后有否发生AF进行分组,并分别对术前、术中和术后资料进行统计和分析。统计学分析采用独立样本t检验和χ2检验。结果 CABG术后早期AF的发生率为21.8%（22/101）,两组比较,AF组平均年龄、体外循环时间和主动脉阻断时间、辅助呼吸时间、术后胸腔引流总量均明显大于非AF组,有显著性差异（P〈0.05）;RCA近-中段狭窄〉50%的患者AF的发生率高达81.8%。性别、心肌梗死史、高血压病史、糖尿病史、LVEF大小和应用洋地黄类药物与否在两组间无统计学意义（P〉0.05）。结论 CABG术后AF的发生率为21.8%,77.3%发生在术后1～3d内。CABG术后AF是多因素造成的,其中一些重要的因素包括：年龄、体外循环时间、辅助呼吸时间、术后胸腔引流总量。RCA近-中段狭窄〉50%为独立危险因素。术前存在AF的患者术后依旧存在AF。采用OPCAB手术方式的患者术后AF的发生率低于CCABG。     

集中式护理干预对脑梗死病人独立生活能力和白介素-6 及肿瘤坏死因子-α水平的影响

目的 探讨集中式护理干预对脑梗死病人独立生活能力、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平的影响。方法 选取郑州大学附属洛阳中心医院2016年3月至2017年3月间收治的122例脑梗死病人作为研究对象。按照随机数字表法将病人分为对照组和观察组,各61例。两组病人均给予抗血小板、改善脑循环、营养神经及相关合并症等常规治疗,对照组病人给予常规护理干预,观察组病人给予集中式护理干预。观察两组病人护理干预3个月后病人独立生活能力、血浆白介素-6及肿瘤坏死因子-α水平情况。结果 观察组病人护理干预后简式Fugl-Meye肢体评分(63.57±12.53)分、改良Barthel指数(MBI)(83.07±9.21)分明显高于对照组Fugl-Meye(57.33±11.44)分、MBI(72.11±8.27)分(t/P=2.872/0.005,6.915/0.000)。观察组病人护理干预后血清IL-6[(28.53±5.37) pg/mL]、TNF-α[(1.53±0.67) pg/mL]均明显低于对照组IL-6[(37.34±4.84) pg/mL]、TNF-α[(2.47±0.71) pg/mL](t=9.518,7.520,均P=0.000)。观察组病人总有效率91.80%明显高于对照组77.05%(χ²=5.050,P=0.024)。结论 集中式的护理干预对于提高脑梗死病人的运动功能、独立生活能力、降低病人血浆IL-6及TNF-α水平有一定的促进作用,对促进脑梗死病人的康复具有一定的应用价值。     

硫氧还蛋白还原酶活性检测在食管癌 60例临床诊断中的应用

目的探究硫氧还蛋白还原酶( TR)活性检测在食管癌临床诊断中的应用。方法 2019年 1月至 2020年 7月海安市人民医院收治的食管癌病人、食管良性病灶病人及同期于该院进行体检的健康者,即分为食管癌组、良性组和对照组,各 60例。分别检测食管癌组、良性组和对照组病人血浆中 TR活性;检测食管癌组织病人化疗前、化疗时和化疗后血浆中 TR活性;比较食管癌组病人 TR活性在不同分期、转移方面的差异;评估食管癌组病人手术预后,随访 2年评估远期预后情况;确定 TR活性检测对食管癌病人的诊断价值。结果与对照组( 3.16±0.79)U/mL相比,良性组( 6.34±0.96)U/mL和食管癌组( 8.12±1.25)U/ mL病人血浆中 TR活性均明显升高( P<0.05);且食管癌病人血浆中 TR活性明显高于良性组( P<0.05)。与化疗前( 8.12±1.25) U/mL相比,化疗时( 4.65±0.87)U/mL和化疗后( 3.37±0.62)U/mL食管癌病人血浆中 TR活性均明显降低( P<0.05);且化疗后食管癌组病人血浆中 TR活性明显低于化疗时( P<0.05)。 TR活性表达和食管癌病人性别、年龄、肿瘤长径和肿瘤位置均无相关性(P>0.05)与病人淋巴结转移和 TNM分期密切相关( P<0.05)。和 Ⅰ＆Ⅱ期食管癌病人相比, Ⅲ&Ⅳ期食管癌病人血浆中 TR活性明显升高(,P<0.05);和未转移食管癌病人相比,食管癌转移病人血浆中 TR活性明显升高( P<0.05)。食管癌病人化疗后有 39例病人得到了完全或部分缓解,病人总有效率为 65%。对食管癌病人随访 2年统计显示,食管癌病人 2年生存率为 75.0%(45例)TR高表达( >4 U/mL)2年生存人数为 31(31/41)例,生存率为 75.6%;TR低表达( <4 U/mL)2年生存率为 14(14/19)例,生存率为7,3.7%;log-rank检验 TR高表达和低表达病人生存率比较差异有统计学意义( P<0.05)。受试者操作特征曲线( ROC曲线)分析 TR检测曲线下面积( AUC)值为 0.92,特异度为 83.2%,灵敏度为 93.6%。结论 TR高表达于食管癌病人血浆中,其可用于食管癌的早期检测,提示病情的进展情况,对病人的治疗预后能有效评价。     

B型利钠肽在老年呼吸困难患者鉴别诊断中的应用价值

目的探讨血浆B型利钠肽原(BNP)水平对老年呼吸困难患者鉴别诊断的应用价值,为正确治疗提供依据。方法收集我院急诊科老年呼吸困难患者159例,入院时检查血浆BNP含量,并给予心脏超声检查,分别比较心源性呼吸和肺源性呼吸困难组BNP水平和左室射血分数的区别;比较心源性呼吸困难组BNP含量与左室射血分数(LVEF)的相关性。结果肺源性呼吸困难组患者BNP含量为(126.7±23.4)pg/mL,心源性呼吸困难组患者BNP含量为(946.8±125.3)pg/mL(P=0.001);相关分析显示老年心源性呼吸困难组BNP与左室射血分数呈负相关关系(r=-0.63,P<0.01)。结论血浆BNP水平检测在老年呼吸困难患者具有一定的鉴别诊断作用,能够反映患者的心功能情况。     

卡维地洛与美托洛尔预防冠脉搭桥术后房颤的疗效比较

目的观察卡维地洛与美托洛尔在冠脉搭桥术后预防房颤的疗效。方法接受冠脉搭桥术的患者共200例,随机分成2组,每组100例,分别给予卡维地洛和美托洛尔治疗。所有患者于术前3 d开始接受药物。美托洛尔组起始剂量50 mg,每日2次;卡维地洛组起始剂量12.5 mg,每日2次。药物的剂量依患者的血流动力学反应进行调整,一直监测到术后第3天。结果美托洛尔组43例(43%)发生房颤,卡维地洛组20例(20%)发生房颤,两组比较,差异有统计学意义(P=0.001)。结论卡维地洛预防冠脉搭桥术后早期房颤的效果优于美托洛尔。     

Role of Phospholipid Transfer Protein on the Plasma Distribution of Amphotericin B Following the Incubation of Different Amphotericin B Formulations

Purpose The purpose of this study was to investigate the role of phospholipid transfer protein (PLTP) on the plasma distribution of amphotericin B (AmpB) following incubation with different AmpB formulations in human plasmas with varying lipid profiles. Methods In a first set of experiments, plasma distribution profiles of AmpB were determined following the incubation of Fungizone? and lipid-based formulations (Abelcet? and AmBisome?) at a concentration of 20 μg AmpB/mL for 5–120 min at 37°C in the plasma obtained from six different individuals (total cholesterol concentrations range between 62 and 332 mg/dL). In a second set of experiments, Abelcet?, and AmBisome? at a concentration of 20 μg AmpB/mL were incubated for 5 min at 37°C in human plasma (total cholesterol = 163 mg/dL) that had been pretreated with an antibody raised up against PLTP (1:400 v/v dilution from stock solution) for 20 min at 37°C. Following incubation, the human plasma was separated into its lipoprotein and lipoprotein-deficient fractions by density gradient ultracentrifugation and analyzed for AmpB content by high-performance liquid chromatography. Results The majority of AmpB was covered in the lipoprotein-deficient plasma and high-density lipoprotein (HDL) fractions following incubation of Fungizone? in human plasma. The majority of AmpB (48.7–87.2%) was recovered in the HDL fraction following incubation of Abelcet? and AmBisome? in human plasma. The presence of the PLTP antibody resulted in a 20% decrease in the percentage AmpB recovered in the HDL fraction following the incubation of Abelcet?. However, the plasma distribution of AmpB remained unchanged following the incubation of AmBisome? in plasma containing the PLTP antibody. Conclusions Taken together, these findings suggest indirect evidence that PLTP may play an important role in the plasma distribution profile of AmpB following the incubation of Abelcet? and may be one of the factors responsible for the preferential association of AmpB with HDL when administered as Abelcet?.     

心房颤动患者氯电流相关通道CIC-3基因表达的研究

目的:研究心房颤动(AF)患者心房组织氯电流相关通道ClC-3的基因表达,探讨AF时心房组织ClC-3的mRNA表达改变及其意义.方法:将71例风湿性心瓣膜病接受换瓣手术患者分为3组:窦性心律组(SR组)31例,阵发性房颤组(PAF组)7例,持续性房颤组(CAF组)33例,术中获取右心耳组织,应用半定量逆转录-聚合酶链反应(RT-PCR)技术检测心房组织ClC-3的mRNA表达的相对含量.结果:与SR组相比,PAF组心房组织中ClC-3的mRNA表达增加,但无显著的统计学意义(P>0.05),CAF组的表达明显增加(P＜0.01),并与AF时程呈明显正相关(r=0.376,P=0.001).结论:房颤患者ClC-3的mRNA表达水平的增加可能是细胞容量调节的氯电流(ICl.VOL)上调的分子基础.     

Cost-effectiveness of amiodarone for prophylaxis of atrial fibrillation in coronary artery bypass surgery.

The cost-effectiveness of amiodarone prophylaxis of atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) was determined. A decision analysis using current hospital data and values from the literature was conducted. Under the base-case scenario, CABG patients received usual care (no prophylaxis) or 2 g of oral amiodarone hydrochloride over one to three days before surgery and 400 mg daily for seven days after surgery. Costs of hospitalization in the intensive care unit (ICU) and the cardiac step-down unit (SDU), cardioversion costs, electrocardiogram costs, drug costs, nursing administration charges, and pharmacy i.v. admixture charges were included. A sensitivity analysis using a Monte Carlo simulation and a one-way sensitivity analysis were performed. The mean cost per AF event avoided was lower in the amiodarone group ($15,750, 95% confidence interval [CI]: $15,591-$15,999) than the control group ($17,426,95% CI: $17,252-$17,600). A majority of the cost difference was due to the cost of hospitalization for patients without AF, the frequency of AF, and the cost of hospitalization in the SDU for patients with AF. For patients treated with amiodarone who did not develop AF, the cost difference was sensitive to changes in the cost of hospitalization and the efficacy of amiodarone. For patients who did develop AF, the cost difference was robust. Prophylaxis of AF with amiodarone in CABG patients was more cost-effective than usual care in the short term from a hospital perspective; the results were sensitive to changes in the cost of hospitalization of patients who did not develop AF and the efficacy of amiodarone.     

Magnesium sulfate for prevention of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting.

PURPOSE: The effects of i.v. magnesium sulfate on the frequency of postoperative atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) and on the frequency of AF at hospital discharge were studied. The effect of postoperative AF on hospital length of stay (LOS) was also assessed. METHODS: A retrospective chart review was performed for all patients who underwent CABG surgery by a single surgeon during 2000-2001 at a community medical center. Patients were eligible for inclusion if they had first-time CABG surgery. Patients who underwent CABG surgery in 2000 did not receive magnesium sulfate and served as controls for the study. Patients were included in the magnesium group if they received 2 g of i.v. magnesium sulfate intraoperatively and 2 g every 12 hours postoperatively for at least two consecutive days. RESULTS: A total of 262 patients underwent CABG during the study period, and 28 were excluded from the study. Of the remaining 234 patients, 99 were in the magnesium group, and 135 were in the control group. No significant differences were found between the study groups in recorded demographic characteristics. Postoperative AF occurred significantly less frequently in the magnesium group (p = 0.038). There was no significant difference between treatment groups in the number of patients discharged in AF (p = 0.307). Among all patients, those with AF were significantly more likely to have a prolonged LOS (p = 0.036). CONCLUSION: CABG patients who received intraoperative and postoperative i.v. magnesium sulfate had a significantly lower rate of AF compared with patients who did not receive the drug. The number of patients discharged with AF was not affected by magnesium administration. AF was associated with a higher likelihood of prolonged postoperative hospitalization.     

Therapeutic drug monitoring of theophylline in frail elderly patients: oral compared with nasogastric tube administration

SUMMARY: Treating debilitated elderly patients through nasogastric tube (NGT) can change the pharmacokinetic characteristics of drugs, mainly those that are slow released (SR). The purpose of this study was to compare pharmacokinetic parameters between patients who receive SR theophylline orally and those who receive it through NGT. PATIENTS AND METHODS: The authors studied elderly patients in the geriatric ward receiving SR theophylline for chronic obstructive lung disease. In 17 patients fed by NGT (group I), theophylline was removed from the capsule and mixed with 10 mL of water. Group II included 15 patients who swallowed the drug orally. Theophylline blood levels were measured, as were peak concentration (C(max) ), time to peak (T(max) ), and area under the serum concentration-time curves (AUC). RESULTS: The mean daily dose was not statistically different between the two groups: 320 +/- 130 (200-500) mg/d in group I and 360 +/- 85 (200-500) mg/d in group II, given twice daily. All pharmacokinetic measurements were lower in group I as compared with group II: trough theophylline blood levels were 3.78 +/- 3.2 (0.5-10.77) microg/mL versus 8.63 +/- 4.6 (0-15.61) microg/mL ( P= 0.002); C(max) was 6.53 +/- 4.1 (1.3-13.33) microg/mL versus 10.51 +/- 3.30 (4.3-16.28) microg/mL (P = 0.0058), and AUC was 50.04 +/- 38.59 (11-112) microg/h/mL versus 80.37 +/- 28.8 (23-148) microg/h/ml (P = 0.024). CONCLUSIONS Patients receiving the drug through NGT had variability and unexpectedly low blood levels. Therefore, the pharmacokinetic parameters of SR preparations should be evaluated before their administration through NGT.     

Effect of prophylactic bisoprolol plus magnesium on the incidence of atrial fibrillation after coronary bypass surgery: results of a randomized controlled trial

OBJECTIVE: Bisoprolol, a highly cardioselective beta(1)-blocker, is widely used to treat elderly patients with hypertension, coronary artery disease and heart failure. The current literature lacks evidence regarding its potency to prevent atrial fibrillation (AF) following cardiac surgery. Therefore the aim of this study was to evaluate the efficacy of bisoprolol plus magnesium (Mg) in the prophylaxis of AF after coronary artery bypass graft (CABG) surgery. RESEARCH DESIGN AND METHODS: A total of 100 consecutive patients subjected to elective on-pump CABG (84 men, age 65 +/- 8 [SD] years), with no prior AF history, were randomly assigned to the prophylaxis group (n = 50) receiving after surgery bisoprolol (5 mg/day) plus Mg (intravenous infusion of 2 g of Mg on arrival in the intensive care unit, followed by oral Mg at 1800 mg/day for 1 week), or to the control group (n = 50), receiving no combined study medication but remaining on their preoperative drugs, including beta-blockers. All patients were continuously monitored to identify the onset of AF. RESULTS: In the prophylaxis group the incidence of postoperative AF was significantly lower, with 20% (10 / 50) compared to 42% (21 / 50) among controls (p = 0.030, 95% confidence interval [CI] for absolute risk reduction [ARR], 2-42%). Particularly in the elderly, bisoprolol plus Mg was effective in preventing AF; in the prophylaxis group only six of 36 (17%) patients > or = 65 years of age developed AF, compared to 13 of 20 (65%) in the control group (p < 0.001, 95% CI for ARR, 17-65%). This was associated with significantly (p = 0.022) shorter hospital stays in the prophylaxis group (median of 7 vs. 9 days, 95% CI for difference in medians, 0-3 days). CONCLUSIONS: The combination of bisoprolol plus Mg effectively reduces the incidence of postoperative AF following on-pump CABG, particularly in elderly patients, and is associated with a shorter hospital length of stay.     

Therapeutic monitoring of amiodarone and desethylamiodarone after surgical ablation of atrial fibrillation-evaluation of the relationship between clinical effect and the serum concentration

BackgroundAssociation between clinical effect and serum concentration of amiodarone (AMI) and its active metabolite desethylamidarone (DEA) in patients after surgical ablation (SA) of atrial fibrillation (AF) has not yet been studied.AimsWe wanted to find a correlation between AMI and DEA serum concentration and maintaining sinus rhythm (SR) after SA of AF.MethodsSixty eight patients with AF who had undergone surgical ablation between 2014 and 2017 were included in a single-centre, prospective, observational study. Maintaining of SR was evaluated by standard 12-lead ECG and 24-hour Holter ECG monitoring at months 1, 3, 6 and 12 following surgery. Therapeutic monitoring of AMI and DEA concentrations was done to optimize therapy and adverse effects were followed up.ResultsWe have noticed a high success rate in maintaining of SR (overall 83%). The median of serum concentration of AMI was 0.81 mg/L (range 0.16–2.35 mg/L) and DEA 0.70 mg/l (range 0.19–2.63 mg/L). No significant differences were found in the serum concentratration of AMI, DEA or DEA/AMI concentratration ratios between patients with SR and persistent supraventricular tachyarrhythmia except on the second outpatient visit. We observed significant correlation between serum concentration of DEA and thyroid-stimulating hormone elevation.ConclusionWe confirmed the efficacy of AMI and DEA at the measured serum concentrations. However, analysis of these concentrations alone cannot replace assessment of the clinical response for treatment. Establishment of individual AMI (and DEA) concentrations at which the optimal therapeutic response is achieved seems to be advantageous. Therapeutic monitoring of AMI and DEA is helpful in personalised pharmacotherapy after SA of AF.     

Dabigatran etexilate in atrial fibrillation patients with severe renal impairment: dose identification using pharmacokinetic modeling and simulation

Dabigatran, administered orally as the prodrug dabigatran etexilate (DE), is a direct thrombin inhibitor shown to be effective in the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). The aim of this analysis was to derive a modeling and simulation-based dose and dosing regimen for AF patients with severe renal failure who could potentially benefit from the use of DE. The exposure was simulated for AF patients with severe renal impairment for several combinations of doses (75, 110, 150 mg) and posologies (BID, QD, Q2D). Simulations were based on a population pharmacokinetic model derived from data from 9522 patients from the pivotal phase III study (RE-LY). Atrial fibrillation patients with a creatinine clearance (CRCL) of <30 to ≥15 mL/min treated with a dose of 75 mg DE BID have target plasma level and exposure data largely within the concentration range proven to be safe and effective in AF patients with CRCL >30 mL/min receiving 150 mg BID. This dosing algorithm was also confirmed and supported by the United States Food and Drug Administration Clinical Pharmacology Division using their model based on the data from the dedicated renal impairment study and taking into account the safety and efficacy information from RE-LY.