Ocní klinika

BACKGROUND: High-density lipoprotein (HDL)-raising therapies are currently under intense evaluation, but the effects of HDL may be highly heterogeneous. We therefore compared the endothelial effects of HDL from healthy subjects and from patients with type 2 diabetes mellitus and low HDL (meeting the criteria for metabolic syndrome), who are frequently considered for HDL-raising therapies. Moreover, in diabetic patients, we examined the impact of extended-release (ER) niacin therapy on the endothelial effects of HDL. METHODS AND RESULTS: HDL was isolated from healthy subjects (n=10) and patients with type 2 diabetes (n=33) by sequential ultracentrifugation. Effects of HDL on endothelial nitric oxide and superoxide production were characterized by electron spin resonance spectroscopy analysis. Effects of HDL on endothelium-dependent vasodilation and early endothelial progenitor cell-mediated endothelial repair were examined. Patients with diabetes were randomized to a 3-month therapy with ER niacin (1500 mg/d) or placebo, and endothelial effects of HDL were characterized. HDL from healthy subjects stimulated endothelial nitric oxide production, reduced endothelial oxidant stress, and improved endothelium-dependent vasodilation and early endothelial progenitor cell-mediated endothelial repair. In contrast, these beneficial endothelial effects of HDL were not observed in HDL from diabetic patients, which suggests markedly impaired endothelial-protective properties of HDL. ER niacin therapy improved the capacity of HDL to stimulate endothelial nitric oxide, to reduce superoxide production, and to promote endothelial progenitor cell-mediated endothelial repair. Further measurements suggested increased lipid oxidation of HDL in diabetic patients, and a reduction after ER niacin therapy. CONCLUSIONS: HDL from patients with type 2 diabetes mellitus and metabolic syndrome has substantially impaired endothelial-protective effects compared with HDL from healthy subjects. ER niacin therapy not only increases HDL plasma levels but markedly improves endothelial-protective functions of HDL in these patients, which is potentially more important. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. Identifier: NCT00346970.

BACKGROUND: The present study aimed at investigating the expression of the Na(+)-Ca2+ exchanger and its functional role in human failing myocardium. METHODS AND RESULTS: Na(+)-Ca2+ exchanger mRNA and protein levels were examined in nonfailing (NF, n = 8) and failing human myocardium (New York Heart Association functional class IV) with idiopathic dilated cardiomyopathy (DCM, n = 8) or ischemic heart disease (ICM, n = 6). The inotropic effect of the Na+ channel activator BDF 9148 was determined in electrically driven left ventricular papillary muscle strip preparations (1 Hz, 37 degrees C) from nonfailing (n = 8) and failing (n = 8) human hearts. Na(+)-Ca2+ exchanger mRNA levels were significantly increased, by 79% (P < .001) in DCM and by 58% (P < .01) in ICM compared with NF; protein levels increased by 36% (P < .001) and by 20% (P < .05), respectively. BDF 9148 increased the force of contraction concentration dependently, with a similar maximal effect in NYHA class IV and NF, but was more potent in NYHA class IV as demonstrated by a significantly smaller (P < .01) EC50 value (NYHA class IV, 0.18 [0.16 to 0.22] mumol/L; NF, 1.65 [1.3 to 3.0] mumol/L). In NYHA class IV, BDF 9148 (0.1 mumol/L) restored the positive force-frequency relationship and reduced the frequency-dependent increase in diastolic tension in relation to force of contraction. CONCLUSIONS: The increased expression of the Na(+)-Ca2+ exchanger is a possible explanation for the increased inotropic potency of the Na+ channel activator BDF 9148 in failing human myocardium. The increase in exchanger molecules could be of functional relevance for the modulation of cardiac contractility by agents that increase the intracellular Na+ concentration. Enhancement of Na(+)-Ca2+ exchanger activity might be a powerful mechanism for increasing cardiac contractility in chronic heart failure.

Forty subjects with chronic hepatitis B and hepatitis B e antigen (HBeAg) seroconversion following lamivudine therapy in previous trials were monitored after treatment to assess the durability of serologic responses. Patient follow-up began a median of 4.3 months after completion of therapy in previous trials. At months 2, 4, 6, 9, and 12 of year 1, and every 6 months thereafter, we tested for HBeAg and hepatitis B surface antigen (HBsAg), hepatitis B virus (HBV) DNA, and alanine aminotransferase (ALT). After a median (range) of 36.6 (4.8-45.6) months of follow-up monitoring, HBeAg seroconversion was demonstrated at the last visit by 77% (30 of 39) of patients. In a post hoc analysis of a slightly different population of all 65 patients with HBeAg seroconversion in previous trials, the 3-year durability of HBeAg seroconversion measured from the time immediately after discontinuing lamivudine therapy was 64%. Nine (9 of 40, 23%) patients were HBsAg negative at the last assessment. Seventy-four percent (17 of 23) of patients with baseline undetectable HBV DNA and normal ALT maintained these responses at the last visit. Eight patients (8 of 40, 20%) initiated retreatment for reappearance of HBV markers, and 7 showed biochemical and/or virologic improvement (including regained HBeAg seroconversion in 2). No safety issues of concern emerged. In conclusion, most HBeAg responses achieved during lamivudine therapy were durable, and most responders experienced prolonged clinical benefit after HBeAg seroconversion and subsequent discontinuation of lamivudine. Lamivudine retreatment for reappearance of hepatitis B markers can achieve resumption of viral suppression.

The intakes of nitrate and nitrite of children and their parents from food and drinking water were estimated in a Finnish nation-wide case-control study on the epidemiology of Type 1 diabetes. The study population consisted of 684 case and 595 control children; 548 case-control pairs of fathers; and 620 case-control pairs of mothers. The consumption frequencies of foods which are important sources of nitrate and nitrite were assessed by structured questionnaire. Nitrate and nitrite concentration data were collected from Finnish water works. Diabetic children's and their mothers' daily dietary intake of nitrite was greater compared with that of control children and mothers (for case and control children 0.9 mg vs 0.8 mg, for case and control mothers 0.9 mg vs 0.8 mg, p < 0.001). Case mothers compared with control mothers received less (p < 0.05) nitrate from their diet. No differences were observed in the intake of nitrate or nitrite from drinking water. Dietary nitrite intake of children (odds ratios and 95% confidence intervals for the second, third, and fourth quartile 1.16, 0.82-1.65; 1.49, 1.06-2.10; 2.32, 1.67-3.24, respectively) and mothers (odds ratios and 95% confidence intervals for the second, third, and fourth quartile 1.15, 0.76-1.74; 1.29, 0.87-1.91; 1.98, 1.35-2.90, respectively) was positively associated with the risk for Type 1 diabetes independently from length of mother's education, child's or mother's age, place of residence or mother's smoking status.(ABSTRACT TRUNCATED AT 250 WORDS)

<h3>Objective</h3> To determine the involvement of subcortical regions in human epilepsy by analyzing direct recordings from these regions during epileptic seizures using stereo-EEG (SEEG). <h3>Methods</h3> We studied the SEEG recordings of a large series of patients (74 patients, 157 seizures) with an electrode sampling the thalamus and in some cases also the basal ganglia (caudate nucleus, 22 patients; and putamen, 4 patients). We applied visual analysis and signal quantification methods (Epileptogenicity Index [EI]) to their ictal recordings and compared electrophysiologic with clinical data. <h3>Results</h3> We found that in 86% of patients, thalamus was involved during seizures (visual analysis) and 20% showed high values of epileptogenicity (EI &gt;0.3). Basal ganglia may also disclose high values of epileptogenicity (9% in caudate nucleus) but to a lesser degree than thalamus (<i>p</i> &lt; 0.01). We observed different seizure onset patterns including low voltage high frequency activities. We found high values of thalamic epileptogenicity in different epilepsy localizations, including opercular and motor epilepsies. We found no difference between epilepsy etiologies (cryptogenic vs malformation of cortical development, <i>p</i> = 0.77). Thalamic epileptogenicity was correlated with the extension of epileptogenic networks (<i>p</i> = 0.02, ρ 0.32). We found a significant effect (<i>p</i> &lt; 0.05) of thalamic epileptogenicity regarding the postsurgical outcome (higher thalamic EI corresponding to higher probability of surgical failure). <h3>Conclusions</h3> Thalamic involvement during seizures is common in different seizure types. The degree of thalamic epileptogenicity is a possible marker of the epileptogenic network extension and of postsurgical prognosis.

Sugammadex as a reversal agent for neuromuscular block: an evidence-based review Stefan Josef Schaller,1,2 Heidrun Fink11Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; 2Department of Anesthesia, Massachusetts General Hospital, Boston, MA, USAAbstract: Sugammadex is the first clinical representative of a new class of drugs called selective relaxant binding agents. It has revolutionized the way anesthesiologists think about drug reversal. Sugammadex selectively binds rocuronium or vecuronium, thereby reversing their neuromuscular blocking action. Due to its 1:1 binding of rocuronium or vecuronium, it is able to reverse any depth of neuromuscular block. So far, it has been approved for use in adult patients and for pediatric patients over 2 years. Since its approval in Europe, Japan, and Australia, further insight on its use in special patient populations and specific diseases have become available. Due to its pharmacodynamic profile, sugammadex, in combination with rocuronium, may have the potential to displace succinylcholine as the "gold standard" muscle relaxant for rapid sequence induction. The use of rocuronium or vecuronium, with the potential of reverse of their action with sugammadex, seems to be safe in patients with impaired neuromuscular transmission, ie, neuromuscular diseases, including myasthenia gravis. Data from long-term use of sugammadex is not yet available. Evidence suggesting an economic advantage of using sugammadex and justifying its relatively high cost for an anesthesia-related drug, is missing. Keywords: reversal agent, cyclodextrin, PORC, SRBAs

The current AF definition requires recording in classical ECG or Holter ECG at least a 30-s episode of AF. According to the current definition, the presence of frequent shorter episodes of fast atrial arrhythmia or episodes of arrhythmia identified with widely used screening tools requires subsequent steps to establish a definite diagnosis of AF. The use of different clinical risk scores can help to refine target populations better. Due to the unpredictable and highly variable nature of AF episodes, a monitoring time lasting 2 weeks or longer is preferable to maximize the possibility of identifying subjects with AF. Several capabilities are currently available for AF search/screening, including devices based on plethysmographic pulse assessment, belts and vests for long-term ECG monitoring, modern Holter capabilities, and ILRs. Decision-making regarding using particular of them should depend on proof of efficacy based on published data, patient characteristics, and purpose of monitoring (screening/search). Additionally, all subjects with CIED with the possibility of atrial sensing should be carefully evaluated to identify AHREs. In large-scale screening projects, ML and AI could provide the appropriate interpretation of large databases containing the results of a giant number of participants. From the patient perspective, participation in screening has positive but also negative aspects. Therefore, each patient should be able to accept or refuse to participate in a screening programme, being fully aware of the potential benefits or hurdles of the screening. As the first step of shared decision-making, identifying a patient’s values, goals, and preferences is mandatory.

A single 4 X 4 system matrix is used to represent the para-axial properties of optical systems consisting of separated obliquely crossed spherocylindrical lenses. The 4 X 4 system matrix is a generalization and combination of the 2 X 2 Gaussian system matrix for spherical optical systems, and the 2 X 2 dioptric power matrix for a single spherocylindrical lens or for obliquely crossed spherocylindrical lenses in contact with each other. The 4 X 4 system matrix approach simplifies both the conceptual and numerical analysis of complicated astigmatic systems.

<h3>BACKGROUND AND PURPOSE:</h3> The 2016 revision of the <i>World Health Organization Classification of Tumors of the Central Nervous System</i> mandates codeletion of chromosomes 1p and 19q for the diagnosis of oligodendroglioma. We studied whether conventional MR imaging features could predict 1p/19q status. <h3>MATERIALS AND METHODS:</h3> Patients with previous 1p/19q testing were identified through pathology department records, typically performed on the basis of an oligodendroglial component on routine histology; 69 patients met the inclusion criteria. Preoperative imaging of patients with grade II or III gliomas was retrospectively assessed by 2 neuroradiologists, blinded to the 1p/19q status. Thirteen MR imaging features were first assessed in a small initial cohort (<i>n</i> = 10), after which the criteria were narrowed for the remaining patients as a validation cohort. <h3>RESULTS:</h3> There was 85% agreement between radiologists for the overall prediction of 1p/19q status in the validation cohort, with an accuracy of 84%. The presence of &gt;50% T2-FLAIR mismatch and calcification was found to be the most useful for predicting 1p/19q status. The &gt;50% T2-FLAIR mismatch variable was demonstrated in 14 tumors and had 100% specificity for identifying a noncodeleted tumor (<i>P</i> = .001), with 97% interobserver correlation. Calcification was visualized in 7 tumors, 6 of which were 1p/19q codeleted (specificity, 97%; <i>P</i> = .006), with 100% interobserver correlation. <h3>CONCLUSIONS:</h3> The presence of &gt;50% T2-FLAIR mismatch is highly predictive of a noncodeleted tumor, while calcifications suggest a 1p/19q codeleted tumor. If formal 1p/19q testing is not possible, a combined MR imaging–histologic assessment may improve the diagnostic accuracy over histology alone.

We report a study of the shapes of the tibial and femoral articular surfaces in sagittal, frontal and coronal planes which was performed on cadaver knees using two techniques, MRI and computer interpolation of sections of the articular surfaces acquired by a three-dimensional digitiser. The findings using MRI, confirmed in a previous study by dissection, were the same as those using the digitiser. Thus both methods appear to be valid anatomical tools. The tibial and femoral articular surfaces can be divided into anterior segments, contacting from 0 degrees to 20 +/- 10 degrees of flexion, and posterior segments, contacting from 20 +/- 10 degrees to 120 degrees of flexion. The medial and lateral compartments are asymmetrical, particularly anteriorly. Posteromedially, the femur is spherical and is located in a conforming, but partly deficient, tibial socket. Posterolaterally, it is circular only in the sagittal section and the tibia is flat centrally, sloping downwards both anteriorly and posteriorly to receive the meniscal horns. Anteromedially, the femur is convex with a sagittal radius larger than that posteriorly, while the tibia is flat sloping upwards and forwards. Anterolaterally, both the femoral and tibial surfaces are largely deficient. These shapes suggest that medially the femur can rotate on the tibia through three axes intersecting in the middle of the femoral sphere, but that the sphere can only translate anteroposteriorly and even then to a limited extent. Laterally, the femur can freely translate anteroposteriorly, but can only rotate around a transverse axis for that part of the arc, i.e., near extension, during which it comes into contact with the tibia through its flattened distal/medial surface as against its spherical posterior surface.

BACKGROUND: Raynaud disease (RD) is a common disorder affecting 3% to 5% of the healthy population, and occurs in more than 90% of patients with connective tissue diseases. The therapeutic options remain limited, particularly in patients with secondary RD due to connective tissue disease. Theoretical considerations lead to the expectation that phosphodiesterase type 5 inhibitors may improve clinical symptoms and digital blood flow in patients with RD. METHODS: We conducted an open-label pilot study in 40 patients with RD, 33 (82%) of whom had secondary and 7 (18%) of whom had primary RD. Digital blood flow was measured by laser-Doppler flowmetry at room temperature and during the cold-exposure test before medical treatment, 1 hour after the initial intake, and after 2 weeks of continuous treatment (10 mg twice a day) with the novel phosphodiesterase type 5 inhibitor vardenafil. Clinical symptoms were recorded by a patient questionnaire and summarized as the Raynaud condition score. RESULTS: Laser-Doppler flowmetry revealed that vardenafil improved digital blood flow in 28 (70%) patients, whereas 12 (30%) did not respond. In individuals responding, digital blood flow significantly increased by a mean +/- SEM of 21.0% +/- 4.9% and 30.0% +/- 5.7% at 1 hour and 2 weeks of treatment at room temperature, respectively, and by 18.8% +/- 4.4% and 35.1% +/- 7.5% at 1 hour and 2 weeks during the cold-exposure test, respectively (P < .01 for all). Consistently, clinical symptoms improved in 27 (68%) of the 40 patients, and the Raynaud condition score declined from a mean +/- SEM of 5.05 +/- 0.38 to 3.54 +/- 0.31 (P < .001). CONCLUSION: Our data indicate that phosphodiesterase type 5 inhibition significantly improves peripheral blood flow and clinical symptoms in a large subset of patients with RD and, thus, may provide a novel therapeutic approach in such individuals.

Dr. W. F. Long pointed out that calculations of decentration in spherocylindrical lenses, as well as calculations of combinations of obliquely crossed spherocylindrical lenses, are considerably simplified by the use of matrix methods. In the obliquely crossed lens problem, Long used eigenvalue techniques to obtain the sphere, cylinder, and axis of the equivalent lens. This paper presents an alternative to the eigenvalue method. This alternative method uses the invariance of the trace and determinant of the dioptric power matrix. This alternative is conceptually easier to understand than the eigenvalue method and perhaps will encourage more people to use the matrix methods.

OBJECTIVE: The purpose of this study was to evaluate the incidence, cause, injury patterns, and MRI findings in knee dislocation in patients with normal and increased body mass index and to determine whether obesity interferes with knee MRI examinations. MATERIALS AND METHODS: A retrospective study of the period from 2000 to 2007 (90 months) was performed at a level 1 trauma center, finding a total of 24 patients who had sustained a knee dislocation. RESULTS: Twenty-two of the 24 patients underwent surgery and 19 patients had an MRI examination of diagnostic quality before surgery. Of the 24 patients, 11 had a body mass index greater than 25 and had knee dislocation due to low-energy trauma (nine due to a simple fall, two to a noncontact sport). Two of these 11 patients were morbidly obese (body mass index>40). These patients had no injuries to the popliteal tendon and they had no irreversible peroneal nerve injuries. Otherwise, the patients' injuries were in agreement with previous knee dislocation studies. Obesity did not interfere with knee MRI examinations. On the basis of the population served by our trauma center, the annual incidence of knee dislocation due to low-energy trauma in overweight patients is about 1.0 per million. CONCLUSION: The annual incidence in obese patients of knee dislocation due to low-energy trauma is not insignificant at a level 1 trauma center. As the prevalence of obesity increases, the injury patterns seen in emergency departments may change. The radiologist should be aware that even after a simple fall, overweight patients may have a knee dislocation.

The 4 x 4 system matrix is applied to corrected astigmatic systems including a schematic eye in which each surface is astigmatic at a different axis. In addition to representing the eye, the 4 x 4 system generates 2 x 2 magnification matrices which describe the meridional magnifications that occur in the presence of astigmatism including the magnifications that occur with bitoric eikonic correcting lenses, or other meridional magnifying systems.

Four patients with acute nonlymphoblastic leukemia and one malignant teratoma refractory to conventional chemotherapy were treated with high doses of cytosine arabinoside (HD ARA-C). They received up to 12 cycles of 1.8 to 3 g/m2 every 12 hours applied by 2-hour infusions. A total of 55 HD ARA-C infusions was performed. All leukemic patients responded. A complete clearance of blasts from the bone marrow was observed in two patients following 8-12 cycles of 3 g/m2. However, relapses occurred after three and seven weeks, in one case with resistance to HD ARA-C. The patient with malignant teratoma did not respond. No severe toxicity emerged even after repeated applications. Adverse reactions included moderate nausea and vomiting (4 patients), diarrhea (2 patients), hepatic dysfunction (1 patient), bone pain (1 patient), blurred vision (1 patient), conjunctivitis (1 patient), and exanthema with partial epidermiolysis (1 patient). Granulocytopenia occurring between 3-8 days after having started the therapy, subsided within 4-25 days. Plasma levels of ARA-C and the metabolite uracil arabinoside (ARA-U) were monitored. At steady state plasma concentrations of ARA-C were 32-97 microM (8-24 micrograms/ml). ARA-C disappeared from the plasma mono- or biphasic with a terminal half-life (t50%) of 7.8-12.6 minutes. The total clearance (Cl) of ARA-C varied between 1.7 and 2.9 liters/kg . h, and the distribution volume (Vss) between 0.44 and 0.86 liters/kg. Cerebrospinal fluid (CSF) levels of ARA-C reached 10-15% of steady state concentrations in plasma.

V těhotenstvĂ­ dochĂĄzĂ­ k ovlivněnĂ­ řady systĂŠmĹŻ včetně muskuloskeletĂĄlnĂ­ho, a to zejmĂŠna axiĂĄlnĂ­ho skeletu. ČastĂ˝m nĂĄsledkem je rozvoj bolestĂ­ v oblasti dolnĂ­ části zad a/nebo pĂĄnve (lumbopelvickĂŠ bolesti), kterĂŠ majĂ­ značnĂ˝ dopad na kvalitu Ĺživota těhotnĂ˝ch a jsou častou příčinou pracovnĂ­ neschopnosti. VĂ˝skyt bolestĂ­ pĂĄnve je popisovĂĄn u 20–65 % těhotnĂ˝ch, nejčastěji udĂĄvanĂĄ prevalence bolestĂ­ dolnĂ­ části zad v těhotenstvĂ­ je kolem 50 %. LumbopelvickĂŠ bolesti mĹŻĹžeme rozdělit na tři kategorie: bolesti dolnĂ­ části zad, bolesti pĂĄnve, kombinovanĂŠ bolesti dolnĂ­ části zad a pĂĄnve. CĂ­lem tohoto sdělenĂ­ je shrnout recentnĂ­ informace o klinickĂŠm obrazu, diagnostice a léčbě lumbopelvickĂ˝ch bolestĂ­ v graviditě.

A pathogenic role for Th17 cells in inflammatory renal disease is well established. The mechanisms underlying their counter-regulation are, however, largely unknown. Recently, Th17 lineage-specific regulatory T cells (Treg17) that depend on activation of the transcription factor Stat3 were identified. We studied the function of Treg17 in the nephrotoxic nephritis (NTN) model of crescentic GN. The absence of Treg17 cells in Foxp3(Cre)×Stat3(fl/fl) mice resulted in the aggravation of NTN and skewing of renal and systemic immune responses toward Th17. Detailed analysis of Stat3-deficient Tregs revealed that the survival, activation, proliferation, and suppressive function of these cells remained intact. However, Tregs from Foxp3(Cre)×Stat3(fl/fl) mice lacked surface expression of the chemokine receptor CCR6, which resulted in impaired renal trafficking. Furthermore, aggravation of NTN was reversible in the absence of Th17 responses, as shown in CD4(Cre)×Stat3(fl/fl) mice lacking both Treg17 and Th17 cells, suggesting that Th17 cells are indeed the major target of Treg17 cells. Notably, immunohistochemistry revealed CCR6-bearing Treg17 cells in kidney biopsy specimens of patients with GN. CCR6 expression on human Treg17 cells also appears dependent on STAT3, as shown by analysis of Tregs from patients with dominant-negative STAT3 mutations. Our data indicate the presence and involvement of Stat3/STAT3-dependent Treg17 cells that specifically target Th17 cells in murine and human crescentic GN, and suggest the kidney-specific action of these Treg17 cells is regulated by CCR6-directed migration into areas of Th17 inflammation.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

◼ catheter ablation ◼ stroke ◼ thrombosis P ulmonary vein isolation (PVI) is an effective strategy for patients with paroxysmal atrial fibrillation (AF). 1 However, in patients with persistent AF and long-standing persistent AF, PVI is associated with limited success, with patients not responding to PVI. 2 Recently, the BELIEF trial (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Longstanding Persistent Atrial Fibrillation Undergoing Catheter Ablation) showed that an electric isolation of the left atrial (LA) appendage (LAA) in addition to PVI could increase clinical success. 3Although potentially effective, this strategy causes electromechanical dissociation of the LAA and was assumed to be associated with increased risk for LAA thrombus and thromboembolism. 4We sought to investigate the incidence of LAA thrombus and thromboembolism and the impact of LAA closure on the prevention of thromboembolic events, in addition to the clinical benefit after left atrial appendage isolation (LAAI).One hundred sixteen patients with AF or atrial tachycardia and LAAI were prospectively enrolled (LAAI group).LAAI was achieved by PVI, linear lesions, and substrate modifications after a median of 2 failed ablation procedures.The patients were compared with a control group of 116 patients with recurrent AF or atrial tachycardia after ≥1 failed AF ablation with PVI, linear lesions, and substrate modifications but without LAAI.The control group was identified by propensity score matching (variables included age, sex, arterial hypertension, diabetes mellitus type II, coronary artery disease, CHA 2 DS 2 -VASc score, LA diameter, and AF type) from our institutional long-term follow-up database (n=551).All subjects gave written informed consent.The study was approved by the institutional review board and was performed in accordance with the Declaration of Helsinki.Our ablation strategies have been described in detail before. 2,5All patients underwent transesophageal echocardiography before the procedure.LAAI was the result of achieving bidirectional block of an anterior and a mitral isthmus line aiming to treat LA macro-reentrant tachycardia or documented localized reentrant atrial tachycardia originating near the LAA base, or it was the result of extensive ablation of complex fractionated atrial electrograms at the anterior LA and mitral isthmus.LAAI was achieved by linear ablation in 104 patients (90%).In 12 patients (10%), the LAA was isolated during extensive ablation of complex fractionated atrial electrograms at the anterior wall and the LA isthmus.Lifelong oral anticoagulation (OAC) was strongly recommended to all patients undergoing LAAI.For control group patients, OAC was continued for ≥3 months.Afterward, OAC was recommended on the basis of the patient's CHA 2 DS 2 -VASc score.ECGs and Holter ECG recordings were performed in our outpatient clinic or by the referring physician on day 1 after procedure; at 1, 3, and 6 months; and at 6-month intervals thereafter.

BACKGROUND: Adding sodium bicarbonate to lidocaine to enhance its efficacy during peripheral nerve block is controversial. The authors studied the effect of adding sodium bicarbonate to lidocaine with and without epinephrine versus equivalent alkalinization by sodium hydroxide (NaOH) on onset, degree, and duration of peripheral nerve block. METHODS: Part I examined alkalinization by sodium bicarbonate versus NaOH to pH 7.8 on 0.5% lidocaine, with and without epinephrine (1:100,000), prepared from crystalline salt. Part II examined 0.5% and 1.0% commercial lidocaine solutions, with and without epinephrine, either unalkalinized or alkalinized with sodium bicarbonate or NaOH. With NaOH, pH was adjusted to 7.8, but with sodium bicarbonate, no pH adjustments were made to simulate clinical conditions. RESULTS: In part I, addition of either NaOH or sodium bicarbonate to 0.5% lidocaine without epinephrine produced a faster onset than did unalkalinized lidocaine, without effecting degree or duration of block. In solutions with epinephrine there were no differences in onset, degree, or duration between lidocaine alkalinized with sodium bicarbonate versus NaOH. In part II, addition of sodium bicarbonate or NaOH to 1.0% commercial lidocaine without epinephrine did not accelerate onset compared with the unalkalinized solution. However, adding sodium bicarbonate decreased the degree and duration of block by 25% and more than 50%, respectively, compared with lidocaine unalkalinized and alkalinized with NaOH. With epinephrine, sodium bicarbonate hastened onset without effecting degree and duration compared with the unalkalinized solution. CONCLUSIONS: With 1% commercial lidocaine without epinephrine, sodium bicarbonate decreases the degree and duration of block. However, in solutions with epinephrine, sodium bicarbonate hastens onset, without effecting degree or duration.