Natriuretic peptides as a prognostic marker for delirium in cardiac aurgery - a pilot study

Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels >64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium

SASE3 Variable Polarization Project at the European XFEL

At the European XFEL, two undulator systems for hard and one for soft X-rays have been successfully put into operation. The SASE3 soft X-ray undulator system generates linearly polarized radiation in the horizontal plane. One of the requirements for extending the radiation characteristics is the ability to obtain different polarization modes. These include both right and left circular, elliptical polarization, or linear polarization at an arbitrary angle. For this purpose, a system consisting of four APPLE X helical undulators developed at the Paul Scherrer Institute (PSI) is used. This paper presents the design parameters of the SASE3 undulator system after modifying it with the helical afterburner. It also describes the methods and the design solutions different from those used at PSI. The status and schedule of the project are introduced