Comorbidity and Prognostic Indicators in Cardiovascular Surgery

Sydän- ja verisuonikirurgisten potilaiden korkean riskin luonnetta on entuudestaan korostanut samanaikainen kirurgisten tekniikoiden ja perioperatiivisen hoidon sekä ei-kirurgisten kajoavien toimenpiteiden ja konservatiivisen hoidon kehitys ja väestön ikääntyminen, minkä johdosta entistä sairaampia potilaita ohjataan kirurgiseen hoitoon. Riskitekijöiden roolin sekä hoitoon liittyvien tyypillisten komplikaatioiden ymmärtäminen onkin nykyään aiempaa tarkeampaa sydän- ja verisuonikirurgiassa leikkaushoidon tulosten optimoimiseksi. Väitöskirjatutkimuksen tavoitteina oli selvittää kolmen keskeisen sydänkirurgiaan liittyvän leikkauksen jälkeisen komplikaation eteisvärinän, myöhäistamponaatioiden ja infektioiden esiintyvyyttä, taudinkuvaa ja riskitekijöitä. Lisäksi tutkimuksessa määritettiin ja vertailtiin vatsa-aortan aneurysman tai tukkivan ääreisvaltimosairauden vuoksi kajoavasti hoidettujen sekä sepelvaltimotaudin vuoksi ohitusleikattujen potilaiden seerumin rasvaprofiilit. Edelleen väitöskirjatyössä tutkittiin seerumin rasva-arvojen yhteyttä pitkän aikavälin kuolleisuuteen vatsa-aortan aneurysman vuoksi hoidetuilla potilailla. Analyyseihin sisällytettiin perinteisten rasva-arvojen ohella uudempia laskennallisia, niin kutsutun Extended Friedewald Formula -neuroverkon avulla määritettyjä rasva-arvoja. Tutkimus kohdistui Tampereen yliopistollisen sairaalan Sydänsairaalassa sekä verisuonikirurgisessa yksikössä vuosien 2001 ja 2014 välillä hoidettuihin potilaisiin. Tiedonkeruu suoritettiin pääosin yksiköiden ylläpitämistä Kardio- ja Vascuset- rekistereista, Tampereen yliopistollisen keskussairaalan potilastietokannasta sekä Fimlab Laboratoriot Oy:n tietokannasta laboratorioarvojen osalta. Analyysit suoritettiin takautuvasti. Tutkimukseen sisällytettiin yhteensä 1 356 sydänkirurgista sekä 498 vatsa-aortan aneurysman vuoksi ja 280 ääreisvaltimotaudin vuoksi hoidettua potilasta. Leikkauksen jälkeisen eteisvärinän (51 %) ja myöhäistamponaatioiden (6.2 %) esiintyvyydet olivat selvästi korkeammat kuin tähänastisissa tutkimuksissa. Eteisvärinän aiempaa suurempi esiintyvyys saattaa liittyä tutkimuspopulaation korkeampaan mediaani-ikään, leikkausta edeltävän eteisvärinän yleisyyteen ja läppätoimenpiteiden suurempaan osuuteen edeltäviin tutkimuksiin verrattuna. Näiden tekijöiden todettiin olevan leikkauksen jälkeisen eteisvärinän itsenäisiä riskitekijöitä vasemman eteisen laajentuman ja päivystyksellisen hoidontarpeen ohella. Myös erot tutkimuksen valintakriteereissä ja aiempaa tarkempi diagnostiikka saattavat selittää korkeita eteisvärinän esiintyvyyslukuja. Myöhaistamponaatioiden puolestaan todettiin olevan yleisempiä nuoremmilla, yleisesti ottaen terveemmillä potilailla, joille tehtiin läppäkirurgisia toimenpiteita. Korkea leikkausta edeltävä hemoglobiiniarvo ja yhden läpän leikkaus olivat itsenäisiä myöhäistamponaatioiden riskitekijoitä. Myös aiemmissa tutkimuksissa on havaittu myöhäistamponaatioiden liittyvän erityisesti läppäkirurgiaan, minkä on arveltu johtuvan näiden toimenpiteiden jälkihoitoon tavanomaisesti liittyvästä verenohennuslääkityksestä. Väitöskirjatyössä havaitun, aiempaa korkeamman myöhäistamponaatioiden esiintyvyyden taustalla saattaa myös olla läppätoimenpiteiden suurentunut osuus kaikista sydänkirurgisista toimenpiteistä tai yksikön leikkauksen jälkeinen dreenihoitoprotokolla. Leikkauksen jälkeisiä infektioita ilmeni noin 10 %:lla sydänkirurgisista potilaista, ja toistuvien hyperglykemioiden todettiin liittyvän merkitsevästi infektiokomplikaatioihin. Infektioiden lisäksi toistuvat hyperglykemiajaksot liittyivät leikkauksenjälkeisiin aivohalvauksiin sekä lisääntyneeseen lyhyen aikavälin kuolleisuuteen. Tutkimusyksikössa noudatettuun tiukkaan verensokeritason säätelyyn ei todettu liittyvän merkittäviä haittavaikutuksia. Seerumin triglyseridit ja LDL-kolesterolitaso olivat merkittäviä pitkän aikavälin kuolleisuuden riskitekijöitä vatsa-aortan aneurysman vuoksi hoidetuilla potilailla, kun taas Extended Friedewald -neuroverkon avulla määritetty IDL-kolesteroli vaikutti olevan merkittavä suojaava tekijä. Lisaksi IDL-kolesterolimäärityksillä pystyttiin täydentämään vatsa-aortan aneurysmien vuoksi hoidettujen potilaiden riskin ennustamista. Lopuksi seerumin korkeampi apolipoproteiini A1-pitoisuus vaikutti olevan yhteydessä ennemmin ohitusleikkausta vaatineeseen sepelvaltimotautiin kuin kajoavasti hoidettuun ääreisvaltimosairauteen.The high-risk nature of cardiovascular surgical patients has become accentuated by the concomitant development of surgical techniques and perioperative care as well as the evolution of other non-surgical invasive procedures and conservative treatment, and by the ageing of the population, resulting in increasingly morbid patients being referred for surgery. In order to optimise the postoperative outcomes, it is now increasingly crucial to understand the role of risk factors in and the characteristic complications of cardiovascular surgery. Firstly, the present thesis studies the occurrence, presentation and predisposing factors of three essential complications in cardiac surgery - postoperative atrial fibrillation, late cardiac tamponade and postoperative infections. Secondly, it ascertains and compares the serum lipid profiles of patients treated for abdominal aortic aneurysms, coronary artery disease and peripheral artery disease and investigates the association of serum lipids with long-term survival in abdominal aortic aneurysm patients. The lipid analyses also include more contemporary lipid parameters estimated computationally with a neural network model, the Extended Friedewald Formula. The patients included in the thesis were treated in the Heart Hospital and the Vascular Surgical Division at Tampere University Hospital between 2001 and 2014. Data was mainly collected from the units' respective databases, Kardio and Vascuset, and from the Tampere University Hospital patient record database. Laboratory values were retrieved from the Fimlab Laboratories Ltd database. The data was analysed retrospectively. A total of 1,356 cardiac surgery, 498 abdominal aortic aneurysm and 280 peripheral artery disease patients were investigated. The incidences of postoperative atrial fibrillation (51%) and late postoperative tamponade or pretamponade (6.2%) were significantly higher than those reported before. The higher occurrence of atrial fibrillation could be due to factors such as a higher median age, a higher prevalence of previous atrial fibrillation and a greater proportion of valvular procedures in the present study compared to earlier research, as these, along with larger left atrium size and emergency surgery, were found to be independent predisposing factors for the condition. Other potential explanations may be linked to the refined inclusion criteria of the present study or to improved diagnostics. Late tamponade, in turn, was most common in younger, generally healthier patients typically undergoing valvular surgery. Independent risk factors included single-valve surgery and a higher preoperative haemoglobin level. The role of valve surgery as a risk factor for late tamponade has been previously established and is suspected to be associated with a concurrent need for anticoagulant therapy. Potential explanations for the higher incidence of late tamponade could lie in the increased proportion of valve procedures in the present study or in the postoperative chest tube management protocols. Ten per cent of the cardiac surgical patients suffered from postoperative infections, and repeated hyperglycaemic episodes were found to be significantly associated with these complications. Increased rates of postoperative stroke and greater short-term mortality were also found in patients with repeated hyperglycaemia episodes, and strict glycaemic control was found to be safe in cardiac surgical patients. In patients treated invasively for abdominal aortic aneurysms, serum triglycerides and low-density lipoprotein cholesterol were associated with increased and intermediate-density lipoprotein cholesterol derived by the Extended Friedevald Formula with decreased long-term mortality. Furthermore, the latter was discovered to significantly complement risk prediction in patients treated for abdominal aortic aneurysms. The findings concerning traditional lipid parameters concurred with previous evidence. Finally, higher serum apolipoprotein A1 levels appeared to be associated with coronary artery disease requiring surgical treatment rather than invasively treated peripheral artery disease

Niacin Cures Systemic NAD(+) Deficiency and Improves Muscle Performance in Adult-Onset Mitochondrial Myopathy

NAD(+) is a redox-active metabolite, the depletion of which has been proposed to promote aging and degenerative diseases in rodents. However, whether NAD(+) depletion occurs in patients with degenerative disorders and whether NAD(+) repletion improves their symptoms has remained open. Here, we report systemic NAD(+) deficiency in adult-onset mitochondrial myopathy patients. We administered an increasing dose of NAD(+) booster niacin, a vitamin B3 form (to 750-1,000 mg/day; clinicaltrials.gov NCT03973203) for patients and their matched controls for 10 or 4 months, respectively. Blood NAD(+) increased in all subjects, up to 8-fold, and muscle-NAD(+) of patients reached the level of their controls. Some patients showed anemia tendency, while muscle strength and mitochondrial biogenesis increased in all subjects. In patients, muscle metabolome shifted toward controls and liver fat decreased even 50%. Our evidence indicates that blood analysis is useful in identifying NAD(+) deficiency and points niacin to be an efficient NAD(+) booster for treating mitochondrial myopathy.Peer reviewe

FT-IR-cPAS—New Photoacoustic Measurement Technique for Analysis of Hot Gases: A Case Study on VOCs

This article describes a new photoacoustic FT-IR system capable of operating at elevated temperatures. The key hardware component is an optical-readout cantilever microphone that can work up to 200 °C. All parts in contact with the sample gas were put into a heated oven, incl. the photoacoustic cell. The sensitivity of the built photoacoustic system was tested by measuring 18 different VOCs. At 100 ppm gas concentration, the univariate signal to noise ratios (1σ, measurement time 25.5 min, at highest peak, optical resolution 8 cm−1) of the spectra varied from minimally 19 for o-xylene up to 329 for butyl acetate. The sensitivity can be improved by multivariate analyses over broad wavelength ranges, which effectively co-adds the univariate sensitivities achievable at individual wavelengths. The multivariate limit of detection (3σ, 8.5 min, full useful wavelength range), i.e., the best possible inverse analytical sensitivity achievable at optimum calibration, was calculated using the SBC method and varied from 2.60 ppm for dichloromethane to 0.33 ppm for butyl acetate. Depending on the shape of the spectra, which often only contain a few sharp peaks, the multivariate analysis improved the analytical sensitivity by 2.2 to 9.2 times compared to the univariate case. Selectivity and multi component ability were tested by a SBC calibration including 5 VOCs and water. The average cross selectivities turned out to be less than 2% and the resulting inverse analytical sensitivities of the 5 interfering VOCs was increased by maximum factor of 2.2 compared to the single component sensitivities. Water subtraction using SBC gave the true analyte concentration with a variation coefficient of 3%, although the sample spectra (methyl ethyl ketone, 200 ppm) contained water from 1,400 to 100k ppm and for subtraction only one water spectra (10k ppm) was used. The developed device shows significant improvement to the current state-of-the-art measurement methods used in industrial VOC measurements

Формирование эмоциональной культуры как компонента инновационной культуры студентов

Homozygosity has long been associated with rare, often devastating, Mendelian disorders1 and Darwin was one of the first to recognise that inbreeding reduces evolutionary fitness2. However, the effect of the more distant parental relatedness common in modern human populations is less well understood. Genomic data now allow us to investigate the effects of homozygosity on traits of public health importance by observing contiguous homozygous segments (runs of homozygosity, ROH), which are inferred to be homozygous along their complete length. Given the low levels of genome-wide homozygosity prevalent in most human populations, information is required on very large numbers of people to provide sufficient power3,4. Here we use ROH to study 16 health-related quantitative traits in 354,224 individuals from 102 cohorts and find statistically significant associations between summed runs of homozygosity (SROH) and four complex traits: height, forced expiratory lung volume in 1 second (FEV1), general cognitive ability (g) and educational attainment (nominal p<1 × 10−300, 2.1 × 10−6, 2.5 × 10−10, 1.8 × 10−10). In each case increased homozygosity was associated with decreased trait value, equivalent to the offspring of first cousins being 1.2 cm shorter and having 10 months less education. Similar effect sizes were found across four continental groups and populations with different degrees of genome-wide homozygosity, providing convincing evidence for the first time that homozygosity, rather than confounding, directly contributes to phenotypic variance. Contrary to earlier reports in substantially smaller samples5,6, no evidence was seen of an influence of genome-wide homozygosity on blood pressure and low density lipoprotein (LDL) cholesterol, or ten other cardio-metabolic traits. Since directional dominance is predicted for traits under directional evolutionary selection7, this study provides evidence that increased stature and cognitive function have been positively selected in human evolution, whereas many important risk factors for late-onset complex diseases may not have been

A Genome-Wide Association Study of Diabetic Kidney Disease in Subjects With Type 2 Diabetes

dentification of sequence variants robustly associated with predisposition to diabetic kidney disease (DKD) has the potential to provide insights into the pathophysiological mechanisms responsible. We conducted a genome-wide association study (GWAS) of DKD in type 2 diabetes (T2D) using eight complementary dichotomous and quantitative DKD phenotypes: the principal dichotomous analysis involved 5,717 T2D subjects, 3,345 with DKD. Promising association signals were evaluated in up to 26,827 subjects with T2D (12,710 with DKD). A combined T1D+T2D GWAS was performed using complementary data available for subjects with T1D, which, with replication samples, involved up to 40,340 subjects with diabetes (18,582 with DKD). Analysis of specific DKD phenotypes identified a novel signal near GABRR1 (rs9942471, P = 4.5 x 10(-8)) associated with microalbuminuria in European T2D case subjects. However, no replication of this signal was observed in Asian subjects with T2D or in the equivalent T1D analysis. There was only limited support, in this substantially enlarged analysis, for association at previously reported DKD signals, except for those at UMOD and PRKAG2, both associated with estimated glomerular filtration rate. We conclude that, despite challenges in addressing phenotypic heterogeneity, access to increased sample sizes will continue to provide more robust inference regarding risk variant discovery for DKD.Peer reviewe

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS: We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS: Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS: We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis

Comorbidity and Prognostic Indicators in Cardiovascular Surgery

Sydän- ja verisuonikirurgisten potilaiden korkean riskin luonnetta on entuudestaan korostanut samanaikainen kirurgisten tekniikoiden ja perioperatiivisen hoidon sekä ei-kirurgisten kajoavien toimenpiteiden ja konservatiivisen hoidon kehitys ja väestön ikääntyminen, minkä johdosta entistä sairaampia potilaita ohjataan kirurgiseen hoitoon. Riskitekijöiden roolin sekä hoitoon liittyvien tyypillisten komplikaatioiden ymmärtäminen onkin nykyään aiempaa tarkeampaa sydän- ja verisuonikirurgiassa leikkaushoidon tulosten optimoimiseksi. Väitöskirjatutkimuksen tavoitteina oli selvittää kolmen keskeisen sydänkirurgiaan liittyvän leikkauksen jälkeisen komplikaation eteisvärinän, myöhäistamponaatioiden ja infektioiden esiintyvyyttä, taudinkuvaa ja riskitekijöitä. Lisäksi tutkimuksessa määritettiin ja vertailtiin vatsa-aortan aneurysman tai tukkivan ääreisvaltimosairauden vuoksi kajoavasti hoidettujen sekä sepelvaltimotaudin vuoksi ohitusleikattujen potilaiden seerumin rasvaprofiilit. Edelleen väitöskirjatyössä tutkittiin seerumin rasva-arvojen yhteyttä pitkän aikavälin kuolleisuuteen vatsa-aortan aneurysman vuoksi hoidetuilla potilailla. Analyyseihin sisällytettiin perinteisten rasva-arvojen ohella uudempia laskennallisia, niin kutsutun Extended Friedewald Formula -neuroverkon avulla määritettyjä rasva-arvoja. Tutkimus kohdistui Tampereen yliopistollisen sairaalan Sydänsairaalassa sekä verisuonikirurgisessa yksikössä vuosien 2001 ja 2014 välillä hoidettuihin potilaisiin. Tiedonkeruu suoritettiin pääosin yksiköiden ylläpitämistä Kardio- ja Vascuset- rekistereista, Tampereen yliopistollisen keskussairaalan potilastietokannasta sekä Fimlab Laboratoriot Oy:n tietokannasta laboratorioarvojen osalta. Analyysit suoritettiin takautuvasti. Tutkimukseen sisällytettiin yhteensä 1 356 sydänkirurgista sekä 498 vatsa-aortan aneurysman vuoksi ja 280 ääreisvaltimotaudin vuoksi hoidettua potilasta. Leikkauksen jälkeisen eteisvärinän (51 %) ja myöhäistamponaatioiden (6.2 %) esiintyvyydet olivat selvästi korkeammat kuin tähänastisissa tutkimuksissa. Eteisvärinän aiempaa suurempi esiintyvyys saattaa liittyä tutkimuspopulaation korkeampaan mediaani-ikään, leikkausta edeltävän eteisvärinän yleisyyteen ja läppätoimenpiteiden suurempaan osuuteen edeltäviin tutkimuksiin verrattuna. Näiden tekijöiden todettiin olevan leikkauksen jälkeisen eteisvärinän itsenäisiä riskitekijöitä vasemman eteisen laajentuman ja päivystyksellisen hoidontarpeen ohella. Myös erot tutkimuksen valintakriteereissä ja aiempaa tarkempi diagnostiikka saattavat selittää korkeita eteisvärinän esiintyvyyslukuja. Myöhaistamponaatioiden puolestaan todettiin olevan yleisempiä nuoremmilla, yleisesti ottaen terveemmillä potilailla, joille tehtiin läppäkirurgisia toimenpiteita. Korkea leikkausta edeltävä hemoglobiiniarvo ja yhden läpän leikkaus olivat itsenäisiä myöhäistamponaatioiden riskitekijoitä. Myös aiemmissa tutkimuksissa on havaittu myöhäistamponaatioiden liittyvän erityisesti läppäkirurgiaan, minkä on arveltu johtuvan näiden toimenpiteiden jälkihoitoon tavanomaisesti liittyvästä verenohennuslääkityksestä. Väitöskirjatyössä havaitun, aiempaa korkeamman myöhäistamponaatioiden esiintyvyyden taustalla saattaa myös olla läppätoimenpiteiden suurentunut osuus kaikista sydänkirurgisista toimenpiteistä tai yksikön leikkauksen jälkeinen dreenihoitoprotokolla. Leikkauksen jälkeisiä infektioita ilmeni noin 10 %:lla sydänkirurgisista potilaista, ja toistuvien hyperglykemioiden todettiin liittyvän merkitsevästi infektiokomplikaatioihin. Infektioiden lisäksi toistuvat hyperglykemiajaksot liittyivät leikkauksenjälkeisiin aivohalvauksiin sekä lisääntyneeseen lyhyen aikavälin kuolleisuuteen. Tutkimusyksikössa noudatettuun tiukkaan verensokeritason säätelyyn ei todettu liittyvän merkittäviä haittavaikutuksia. Seerumin triglyseridit ja LDL-kolesterolitaso olivat merkittäviä pitkän aikavälin kuolleisuuden riskitekijöitä vatsa-aortan aneurysman vuoksi hoidetuilla potilailla, kun taas Extended Friedewald -neuroverkon avulla määritetty IDL-kolesteroli vaikutti olevan merkittavä suojaava tekijä. Lisaksi IDL-kolesterolimäärityksillä pystyttiin täydentämään vatsa-aortan aneurysmien vuoksi hoidettujen potilaiden riskin ennustamista. Lopuksi seerumin korkeampi apolipoproteiini A1-pitoisuus vaikutti olevan yhteydessä ennemmin ohitusleikkausta vaatineeseen sepelvaltimotautiin kuin kajoavasti hoidettuun ääreisvaltimosairauteen.The high-risk nature of cardiovascular surgical patients has become accentuated by the concomitant development of surgical techniques and perioperative care as well as the evolution of other non-surgical invasive procedures and conservative treatment, and by the ageing of the population, resulting in increasingly morbid patients being referred for surgery. In order to optimise the postoperative outcomes, it is now increasingly crucial to understand the role of risk factors in and the characteristic complications of cardiovascular surgery. Firstly, the present thesis studies the occurrence, presentation and predisposing factors of three essential complications in cardiac surgery - postoperative atrial fibrillation, late cardiac tamponade and postoperative infections. Secondly, it ascertains and compares the serum lipid profiles of patients treated for abdominal aortic aneurysms, coronary artery disease and peripheral artery disease and investigates the association of serum lipids with long-term survival in abdominal aortic aneurysm patients. The lipid analyses also include more contemporary lipid parameters estimated computationally with a neural network model, the Extended Friedewald Formula. The patients included in the thesis were treated in the Heart Hospital and the Vascular Surgical Division at Tampere University Hospital between 2001 and 2014. Data was mainly collected from the units' respective databases, Kardio and Vascuset, and from the Tampere University Hospital patient record database. Laboratory values were retrieved from the Fimlab Laboratories Ltd database. The data was analysed retrospectively. A total of 1,356 cardiac surgery, 498 abdominal aortic aneurysm and 280 peripheral artery disease patients were investigated. The incidences of postoperative atrial fibrillation (51%) and late postoperative tamponade or pretamponade (6.2%) were significantly higher than those reported before. The higher occurrence of atrial fibrillation could be due to factors such as a higher median age, a higher prevalence of previous atrial fibrillation and a greater proportion of valvular procedures in the present study compared to earlier research, as these, along with larger left atrium size and emergency surgery, were found to be independent predisposing factors for the condition. Other potential explanations may be linked to the refined inclusion criteria of the present study or to improved diagnostics. Late tamponade, in turn, was most common in younger, generally healthier patients typically undergoing valvular surgery. Independent risk factors included single-valve surgery and a higher preoperative haemoglobin level. The role of valve surgery as a risk factor for late tamponade has been previously established and is suspected to be associated with a concurrent need for anticoagulant therapy. Potential explanations for the higher incidence of late tamponade could lie in the increased proportion of valve procedures in the present study or in the postoperative chest tube management protocols. Ten per cent of the cardiac surgical patients suffered from postoperative infections, and repeated hyperglycaemic episodes were found to be significantly associated with these complications. Increased rates of postoperative stroke and greater short-term mortality were also found in patients with repeated hyperglycaemia episodes, and strict glycaemic control was found to be safe in cardiac surgical patients. In patients treated invasively for abdominal aortic aneurysms, serum triglycerides and low-density lipoprotein cholesterol were associated with increased and intermediate-density lipoprotein cholesterol derived by the Extended Friedevald Formula with decreased long-term mortality. Furthermore, the latter was discovered to significantly complement risk prediction in patients treated for abdominal aortic aneurysms. The findings concerning traditional lipid parameters concurred with previous evidence. Finally, higher serum apolipoprotein A1 levels appeared to be associated with coronary artery disease requiring surgical treatment rather than invasively treated peripheral artery disease

The duration of mediastinal chest tube drainage is not associated with postoperative pain or opioid consumption after cardiac surgery

Objectives. Mediastinal chest tubes are considered to be a significant factor causing postoperative pain after cardiac surgery. The aim of the study was to ascertain whether the duration of mediastinal drainage is associated with postoperative pain and opioid consumption. Design. A total of 468 consecutive patients undergoing cardiac surgery at the Tampere University Hospital between December 2015 and August 2016 were retrospectively analyzed. The first 252 patients were treated according to short and the following 216 patients according to extended drainage protocol, in which the mediastinal chest tubes were habitually removed on the first and second postoperative day, respectively. The oxycodone hydrochloride consumption, as well as daily mean pain scores assessed by numeric/visual rating scales, were compared between the groups. Results. The mean daily pain scores and cumulative opioid consumption were similar in both groups. Patients with reduced ejection fraction, diabetes, and peripheral vascular disease reported lower initial pain scores. The median cumulative oxycodone hydrochloride consumption did not differ according to the drainage protocol but was higher in males, smokers, and after aortic surgery. In contrast, patients with advanced age, hypertension, and peripheral vascular disease had lower consumption. In multivariable analysis, male sex and aortic surgery were associated with higher and advanced age with lower opioid use. Conclusions. The length of mediastinal chest tube drainage is not associated with the amount of postoperative pain or need for opioids after cardiac surgery. Male sex and aortic surgery were associated with higher and advanced age with lower overall opioid consumption.publishedVersionPeer reviewe