Achieving ventricular rate control using metoprolol in beta-blocker naïve patients versus patients on chronic beta-blocker therapy

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Patricia Kuang, Nathan D. Mah, Cassie A. Barton, Andrea J. Miura, Laura R. Tanas, Ran Ran
Study ObjectiveTo evaluate the difference in ventricular rate control using an intravenous (IV) metoprolol regimen commonly used in clinical practice in patients receiving chronic beta-blocker therapy compared to patients considered beta-blocker naïve admitted to the emergency department (ED) for atrial fibrillation (AF) with rapid ventricular rate (RVR).MethodsA single-center retrospective cohort study of adult ED patients who were admitted with a rapid ventricular rate of 120 beats per minute (bpm) or greater and treated with IV metoprolol was performed. Rate control was defined as either a decrease in ventricular rate to less than 100 bpm or a 20% decrease in heart rate to less than 120 bpm after metoprolol administration. Patient demographics, differences in length of stay and adverse events were recorded.ResultsA total of 398 patients were included in the study, with 79.4% (n=316) receiving chronic beta-blocker therapy. Patients considered to be beta-blocker naïve were more likely to achieve successful rate control with IV metoprolol compared to patients on chronic beta-blocker therapy (56.1% versus 42.4%, p = 0.03). Beta-blocker naïve status was associated with a shorter length of stay in comparison to patients receiving chronic beta-blocker therapy (1.79 days versus 2.64 days, p <0.01).ConclusionIntravenous metoprolol for the treatment of AF with RVR was associated with a higher treatment response in patients considered beta-blocker naïve compared to patients receiving chronic beta-blocker therapy.

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Physical exercise modulates the homeostasis of human regulatory T cells

A sedentary lifestyle increases the risk for various medical conditions, whereas regular physical activity (PA) has been shown to promote health and reduce the risk of developing chronic disorders such as cardiovascular disease and cancer, which are prevalent in industrialized countries.1 The cellular and molecular mechanisms by which PA mediates its beneficial effects are poorly understood. Because a common etiologic factor for many noncommunicable diseases of affluence is persistent sterile inflammation, PA could exert part of its effects by dampening chronic low-grade inflammation.

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Big atria, little P-waves: unexpected mismatch between chamber volume and electrocardiogram signal in “false” atrial-fibrillation

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Giuseppe Carpagnano, Riccardo Ieva, Michele Correale, Matteo Di Biase, Natale Daniele Brunetti

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Chromosomal microarray provides enhanced targetable gene aberration detection when paired with next generation sequencing panel in profiling lung and colorectal tumors

Publication date: Available online 6 January 2016
Source:Cancer Genetics
Author(s): S Mukherjee, Z Ma, S Wheeler, M Sathanoori, C Coldren, JL Prescott, N Kozyr, M Bouzyk, M Correll, H Ho, P Chandra, PA Lennon
Development of targeted therapies based on specific genomic alterations have altered the treatment and management of lung and colorectal cancers. Chromosomal microarray (CMA) has allowed identification of copy number variations (CNVs) in lung and colorectal cancers in great detail, and Next-Generation Sequencing (NGS) is used extensively to analyze the genome of cancers for molecular subtyping and use of molecularly guided therapies. The main objective of this study was to evaluate the utility of combining CMA and NGS for a comprehensive genomic assessment of lung and colorectal adenocarcinomas, especially for detecting drug targets. We compared results from NGS and CMA data from 60 lung and 51 colorectal tumors. From CMA analysis, 33% were amplified, 89% showed gains, 75% showed losses and 41% demonstrated loss of heterozygosity; pathogenic variants were identified in 81% of colon and 67% lung specimens through NGS. KRAS mutations commonly occurred with loss in TP53 and there was significant loss of BRCA1 and NF1 among male patients with lung cancer. For clinically actionable targets, 23% had targetable CNVs when no pathogenic variants were detected by NGS. The data thus indicates that combining the two approaches provides significant benefit in a routine clinical setting not available by NGS alone.

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Effects of platelet-rich plasma in association with bone grafts in maxillary sinus augmentation: a systematic review and meta-analysis

This systematic review evaluated the effect on bone formation and implant survival of combining platelet-rich plasma (PRP) with bone grafts in maxillary augmentation. A comprehensive review of articles listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases covering the period January 2000 to January 2015 was performed. The meta-analysis was based on bone formation for which the mean difference (MD, in millimetres) was calculated. Implant survival was assessed as a dichotomous outcome and evaluated using the risk ratio (RR) with 95% confidence interval (CI).

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Prospective, Randomized, Double Blind Controlled Trial Comparing Vapocoolant Spray versus Placebo Spray in Adults Undergoing Venipuncture

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Sharon E. Mace
IntroductionTopical anesthetics are used to decrease procedural pain such as venipuncture. Advantages of vapocoolants include rapid onset, ease of application, low cost, and lack of associated pain of injection and other needle stick-related risks. We hypothesized that the pain of venipuncture would be reduced by at least 1.8 points on a 10-point numerical rating scale after application of a vapocoolant compared with placebo.MethodsWe conducted a prospective, randomized, double blind controlled trial of vapocoolant versus placebo spray in 100 adults (ages 18 – 80) requiring venipuncture in a hospital emergency department or observation unit. The primary efficacy outcome was the difference in pain scores immediately after venipuncture, measured on a 10-point verbal numeric rating scale from 0 (none) to worst Rodriguez and Jordan (2002) . Safety outcomes included local adverse effects (edema, erythema, blanching) and changes in vital signs.ResultsPatient characteristics and venipuncture procedure were not significantly different for the two groups. The median (inter-quartile range) pain of venipuncture was 3 (1.2-5) in the placebo group and 1 (0-3) in the vapocoolant group, P < 0.001. Skin checklist revealed vapocoolant: minimal blanching 4%, minimal erythema 18% which resolved within 5 minutes; placebo: no visible skin changes. Photographs at 5-10 minutes revealed no visible skin changes in any patient. Complaints were two: "very wet and cold on skin" (placebo) and "felt burning on skin" (vapocoolant).ConclusionThe vapocoolant significantly decreased venipuncture pain in adults compared with placebo and was well tolerated with minor side effects that resolved quickly. There were no significant differences in VS and no visible skin changes documented at the site by photographs taken within 5-10 minutes post spray/venipuncture.

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New drug may overcome treatment resistance in a high-risk children’s cancer

Paediatric oncologists from The Children's Hospital of Philadelphia (CHOP) have reported their latest results in devising new treatments for stubbornly deadly forms of the childhood cancer neuroblastoma. Building on their previous experiences in treating…

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