Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery:an observational study

Background: All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods: Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac surgery patients were assigned to one of two groups receiving PAB with a second-generation cephalosporin for either 56 h (group I) or 32 h (group II). Patients' characteristics, intraoperative data, and the in-hospital follow-up were analysed. Primary endpoint was the incidence of surgical site infection (deep and superficial sternal wound-, and vein harvesting site infection; DSWI/SSWI/VHSI). Secondary endpoints were the incidence of respiratory-, and urinary tract infection, as well as the mortality rate. Results: 615/1096 patients (56,1%) were enrolled (group I: n = 283 versus group II: n = 332). There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. No statistically significant differences were demonstrated concerning primary and secondary endpoints. The incidence of DSWI/SSWI/VHSI were 4/283 (1,4%), 5/283 (1,7%), and 1/283 (0,3%) in group I versus 6/332 (1,8%), 9/332 (2,7%), and 3/332 (0,9%) in group II (p = 0,76/0,59/0,63). In univariate analyses female gender, age, peripheral arterial obstructive disease, operating-time, ICU-duration, transfusion, and respiratory insufficiency were determinants for nosocomial infections (all Conclusions: Reducing the duration of PAB from 56 h to 32 h in adult cardiac surgery patients was not associated with an increase of nosocomial infection rate, but contributes to reduce antibiotic resistance and health care costs

Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium.

BACKGROUND: The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment. METHODS: In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol. FINDINGS: Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48·7%] women; median age 51·0 years [IQR 40·7-59·7]). 199 415 individuals were included in the derivation cohort (91 786 [48·4%] women) and 199 431 (92 269 [49·1%] women) in the validation cohort. During a maximum follow-up of 43·6 years (median 13·5 years, IQR 7·0-20·1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease event-rates for increasing non-HDL cholesterol categories (from 7·7% for non-HDL cholesterol <2·6 mmol/L to 33·7% for ≥5·7 mmol/L in women and from 12·8% to 43·6% in men; p<0·0001). Multivariable adjusted Cox models with non-HDL cholesterol lower than 2·6 mmol/L as reference showed an increase in the association between non-HDL cholesterol concentration and cardiovascular disease for both sexes (from hazard ratio 1·1, 95% CI 1·0-1·3 for non-HDL cholesterol 2·6 to <3·7 mmol/L to 1·9, 1·6-2·2 for ≥5·7 mmol/L in women and from 1·1, 1·0-1·3 to 2·3, 2·0-2·5 in men). The derived tool allowed the estimation of cardiovascular disease event probabilities specific for non-HDL cholesterol with high comparability between the derivation and validation cohorts as reflected by smooth calibration curves analyses and a root mean square error lower than 1% for the estimated probabilities of cardiovascular disease. A 50% reduction of non-HDL cholesterol concentrations was associated with reduced risk of a cardiovascular disease event by the age of 75 years, and this risk reduction was greater the earlier cholesterol concentrations were reduced. INTERPRETATION: Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician-patient communication about primary prevention strategies. FUNDING: EU Framework Programme, UK Medical Research Council, and German Centre for Cardiovascular Research

Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality.

BACKGROUND: Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking. METHODS: We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified according to geographic region, age, and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality. RESULTS: Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants died during a median follow-up of 8.7 years (maximum, 47.6). For all five risk factors combined, the aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6). Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease among women and men, respectively, and 22.2% and 19.1% of deaths from any cause among women and men, respectively, may be attributable to five modifiable risk factors. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.)

Substrate interactions of rat organic cation transporter 1 (rOCT1) relevant for transport

Im Rahmen der vorliegenden Arbeit wurde das mechanistische Funktionsprinzip des Rat Organic Cation Transporter 1, stellvertretend für die Gruppe der organischen Kationentransporter, im Hinblick auf die Beteiligung einzelner Aminosäuren der mutmaßlichen Bindungstasche am Transportprozess (Tyr222, Asp475) untersucht. Hierbei stand insbesondere die Frage nach einer gleichzeitigen oder sequentiellen Interaktion der o. g. Aminosäuren mit dem jeweils gewählten Transportliganden im Vordergrund. Bei Mutation der untersuchten Interaktionsstellen (Einzelmutanten Y222F, D475E, Doppelmutante Y222F/D475E) konnten Km-Änderungen für die zelluläre Aufnahme von MPP und TEA sowie IC50-Änderungen für die Hemmung des MPP-Transportes durch TEA bzw. TBuA im Xenopus-laevis-Oozytenmodell mittels radioaktiver Aufnahmemessungen erzielt werden. Trotz eines signifikant additiven Effektes der Doppelmutation auf die TEA-Affinität des Transporters im Vergleich zu den Einzelmutanten erschien ein sequentieller Transportmechanismus aufgrund der nicht additiven IC50(TEA)-Verminderung für den MPP-Transport und der Sicherung der Lokalisation von Tyr222 und Asp475 auf unterschiedlichen Seiten der Plasmamembran durch TBuA-Inhibitionsversuche der MPP-Aufnahme wahrscheinlich. Gestützt wurden diese Ergebnisse durch die analoge Modellierung dreidimensionaler Darstellungen des doppelmutierten rOCT1(Y222F/D475E) anhand bereits kristallographisch vermessener Prokaryotentransporter. Diese Modelle bestätigten eine interaktionsrelevante räumliche Position der modifizierten Aminosäurereste innerhalb der Bindungstasche, welche eine metachrone Substrat- bzw. Inhibitorbindung nahelegte. Demnach interagiert in Kongruenz beider Untersuchungsansätze zunächst Tyr222 auf extrazellulärer Seite mit dem Liganden, während der intramembranären Konformationsänderung des Transporters erfolgt dann eine Transposition des Substrates respektive Inhibitors auf Asp475 auf der Zytosolseite.The involvement of two amino acids (Y222, D475) of the innermost cavity of rat organic cation transporter 1 (rOCT1) in the transport process was investigated. The study aimed at characterizing the interaction between substrates and the amino acid residues as a synchronous or sequential process. Mutations of the above mentioned amino acids (Y222F, D475E, Y222F/D475E) showed a significantly additive effect on TEA affinity in contrast to MPP for the double mutant on one hand. On the other hand there was no additive decrease in IC50(TEA) values for MPP transport. Additionally, the accessibility of Y222 and D475 on different sides of the plasma membrane during transport was verified by TBuA inhibition of MPP translocation. Taken together these findings strongly suggest a sequential transport mechanism. This interpretation of the experimental data was also supported by computer based three dimensional modelling of the Y222F/D475E double mutant with substrates/inhibitors bound to the innermost cavitiy, which showed the positions of the two amino acids within the tertiary structure of rOCT1 to be suitable for metachronous substrate interactions

Coating method for forming flame retardant substrate

A method includes coating a substrate to provide a flame resistant substrate. In an embodiment, the method includes preparing an aqueous solution. The aqueous solution comprises a phosphate material, a cationic material, and a water. The method further includes exposing the substrate to the aqueous solution to produce a coating on the substrate. The coating includes the cationic material and the phosphate material. The method also includes exposing the coating on the substrate to a melamine solution.U

Coating method for forming flame retardant substrate

A method includes coating a substrate to provide a flame resistant substrate. In an embodiment, the method includes preparing an aqueous solution. The aqueous solution comprises a phosphate material, a cationic material, and a water. The method further includes exposing the substrate to the aqueous solution to produce a coating on the substrate. The coating includes the cationic material and the phosphate material. The method also includes exposing the coating on the substrate to a melamine solution.U

Coating method for forming flame retardant substrate

A method includes coating a substrate to provide a flame resistant substrate. In an embodiment, the method includes preparing an aqueous solution. The aqueous solution comprises a phosphate material, a cationic material, and a water. The method further includes exposing the substrate to the aqueous solution to produce a coating on the substrate. The coating includes the cationic material and the phosphate material. The method also includes exposing the coating on the substrate to a melamine solution.U

Coating method for forming flame retardant substrate

A method includes coating a substrate to provide a flame resistant substrate. In an embodiment, the method includes preparing an aqueous solution. The aqueous solution comprises a phosphate material, a cationic material, and a water. The method further includes exposing the substrate to the aqueous solution to produce a coating on the substrate. The coating includes the cationic material and the phosphate material. The method also includes exposing the coating on the substrate to a melamine solution.U