Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: a controlled, prospective observational study

BACKGROUND: The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. METHODS: Forty-two patients, who were >/= 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. RESULTS: The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. CONCLUSIONS: In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients

Peregrine's system revisited

43 pages, 91 references, 15 figures, 2 tables. Other author's papers can be downloaded at http://www.denys-dutykh.com/International audiencePeregrine's system revisited arXiv.org / halIn 1967 D. H. Peregrine proposed a Boussinesq-type model for long waves in shallow waters of varying depth. This prominent paper turned a new leaf in coastal hydrodynamics along with contributions by F. Serre, A. E. Green & P. M. Naghdi and many others since then. Several modern Boussinesq-type systems stem from these pioneering works. In the present work we revise the long wave model traditionally referred to as the Peregrine system. Namely, we propose a modification of the governing equations which is asymptotically similar to the initial model for weakly nonlinear waves, while preserving an additional symmetry of the complete water wave problem. This modification procedure is called the invariantization. We show that the improved system has well conditioned dispersive terms in the swash zone, hence allowing for efficient and stable run-up computations