QT and TdP. QT: an unreliable predictor of proarrhythmia

When triangulation, reverse use dependence, instability and dispersion (TRIaD) of the action potential are associated with drug-induced prolongation of the QT interval, then proarrhythmia in the form of torsade de pointes is most likely. However, as the QT interval is shortened, TRIaD increasingly leads to ventricular fibrillation (VF). Thus, use of QT prolongation by itself may not recognize drug-induced VF (false negatives) and in the absence of TRIaD may erroneously incriminate valuable and safe agents (false positives). In patients,TRIaD equivalents in the ECG may likewise be more important than QT interval.     

Association of hypertensive status and its drug treatment with lipid and haemostatic factors in middle-aged men: the PRIME study

Aims: To assess the association of hypertensive status and antihypertensive drug treatment with lipid and haemostatic levels in middle-aged men.Methods and results: Hypertensive status, antihypertensive drug treatment, total and high-density lipoprotein (HDL) cholesterol, triglyceride, apoproteins A-I and B, lipoparticles LpA-I, LpE:B and Lp(a), fibrinogen, plasminogen activator inhibitor-1 (PAI-1) activity and factor VII were assessed in a sample of men 50-59 years living in France (n = 7050) and Northern Ireland (n = 2374). After adjustment for age, body mass index, smoking status, educational level, country, alcohol drinking and hypolipidaemic drug treatment, untreated hypertensive subjects had higher levels of total cholesterol, triglyceride, apoproteins A-I and B and PAI-I activity than normotensive subjects. On univariate analysis, diuretics decreased total and HDL-cholesterol and apoproteins A-I and B; those differences remained after multivariate adjustment. Treatment with beta-blockers decreased total and HDL-cholesterol, apoprotein A-I and LpA-I, and this effect remained after multivariate adjustment. Calcium channel blockers decreased total cholesterol and apoproteins A-I and B; those differences remained significant after multivariate adjustment. ACE inhibitors decreased total cholesterol, triglycerides, apoprotein B and LpE:B; and this effect remained after multivariate adjustment. Analysis of the subjects on monotherapy showed beta-blockers to decrease total cholesterol and HDL parameters and angiotensin-converting enzyme (ACE) inhibitors to decrease low-density lipoprotein (LDL)-related parameters, while no effect was found for the other antihypertensive drugs.Conclusions: Hypertensive status is associated with an unfavourable lipid and haemostatic profile in middle-aged men. Antihypertensive treatment with beta-blockers decreases HDL parameters, whereas treatment with ACE inhibitors appears to decrease total cholesterol and LDL-related parameters.     

Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure.

Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ systems in isolation. The non-invasive, dynamic physiological overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. The use of CPET in management of the chronic heart failure patient is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are predicted better by indices of exercise tolerance than by resting measurements. Our aim is to produce a statement which provides recommendations on the interpretation and clinical application of CPET in heart failure, based on contemporary scientific knowledge and technical advances: the focus is on clinical indications, issues of standardization, and interpretative strategies for CPET.     

Churg‐Strauss syndrome with poor‐prognosis factors: A prospective multicenter trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in forty‐eight patients

Objective

To compare long and short durations of adjunctive cyclophosphamide for the treatment of severe Churg‐Strauss syndrome (CSS).

Methods

In this prospective multicenter therapeutic trial, 48 patients with CSS with at least 1 poor‐prognosis factor at baseline were treated with glucocorticoids and either 12 or 6 intravenous cyclophosphamide pulses.

Results

At 8 years, complete remission rates and severe side effects of therapy were comparable for both groups. The overall difference in relapses was not significant between the 12‐pulse and the 6‐pulse regimens (P = 0.07), but when considering only the number of mild relapses this difference became statistically significant (P < 0.02). Although the total number of inclusions was not reached, the study was stopped prematurely in response to the superiority of the 12‐pulse regimen.

Conclusion

We concluded that 12 cyclophosphamide pulses were better able to control severe CSS than a 6‐pulse regimen. The optimal duration of therapy remains to be determined.     

Observation learning of a motor task: who and when?

Observation contributes to motor learning. It was recently demonstrated that the observation of both a novice and an expert model (mixed observation) resulted in better learning of a complex spatiotemporal task than the observation of either a novice or an expert model. In experiment 1, we aimed to determine whether mixed observation better promotes learning due to the information that can be gained from two models who exhibit different skill levels or simply because multiple models, regardless of their level of expertise, better promote learning than would a single model. The results revealed that the observation of both an expert and a novice model resulted in better short-term retention than the observation of either two novice or two expert models. In experiment 2, we wanted to determine whether these benefits would last longer if physical practice trials were interspersed with observation. Mixed and (to some extent) expert observations resulted in better long-term retention than observation of a novice model. We suggest that alternating mixed/expert observation with physical practice trials makes one’s error more salient than when all observation trials are completed before one first starts performing the experimental task, which increases activation of the action observation network.     

Accuracy of non-guided versus ultrasound-guided injections in cervical muscles: a cadaver study

Journal of Neurology - The col-cap concept encouraged neurologists to inject a large group of muscles in the treatment of cervical dystonia. This includes deep muscles such as the obliquus capitis...     

Depression and anxiety levels in patients with temporomandibular disorders: comparison with the general population

Clinical Oral Investigations - The objective of this study was to compare levels of depression and anxiety of a group of patients with orofacial pain attributed to a temporomandibular disorder...