2 research outputs found
The Effect of Biochemical Remission on Bone Metabolism in Cushing's Syndrome: A 2âYear FollowâUp Study
Endogenous Cushing's syndrome (CS) is a rare cause of secondary osteoporosis. The longâterm consequences for bone metabolism after successful surgical treatment remain largely unknown. We assessed bone mineral density and fracture rates in 89 patients with confirmed Cushing's syndrome at the time of diagnosis and 2âyears after successful tumor resection. We determined five bone turnover markers at the time of diagnosis, 1 and 2âyears postoperatively. The bone turnover markers osteocalcin, intact procollagenâINâpropeptide (PINP), alkaline bone phosphatase, CTXâI, and TrAcP 5b were measured in plasma or serum by chemiluminescent immunoassays. For comparison, 71 sexâ, ageâ, and body mass index (BMI)âmatched patients in whom Cushing's syndrome had been excluded were studied. None of the patients received specific osteoanabolic treatment. At time of diagnosis, 69% of the patients had low bone mass (mean Tâscore = â1.4â±â1.1). Two years after successful surgery, the Tâscore had improved in 78% of patients (mean Tâscore 2âyears postoperatively â1.0â±â0.9). The bone formation markers osteocalcin and intact PINP were significantly decreased at time of diagnosis (p â€â0.001 and p =â0.03, respectively), and the bone resorption marker CTXâI and TrAcP 5b increased. Postoperatively, the bone formation markers showed a threeâ to fourfold increase 1âyear postoperatively, with a moderate decline thereafter. The bone resorption markers showed a similar but less pronounced course. This study shows that the phase immediately after surgical remission from endogenous CS is characterized by a high rate of bone turnover resulting in a striking net increase in bone mineral density in the majority of patients
Nonâinvasive evaluation of newâonset atrial fibrillation after cardiac surgery: a protocol for the BigMap study
Abstract Aims Newâonset atrial fibrillation (NOAF) is the most common complication after cardiac surgery, occurring in 25â50% of patients. It is associated with postâoperative stroke, increased mortality, prolonged hospital length of stay, and higher treatment costs. Previous small observational studies have identified the left atrium as a source of the electrical rotors and foci maintaining NOAF, but confirmation by a large prospective clinical study is still missing. The aim of the proposed study is to investigate whether the source of NOAF lies in the left atrium. The correct identification of NOAFâmaintaining structures in cardiac surgical patients might offer potential therapeutic targets for prophylactic perioperative ablation strategies. Methods and results This is a prospective singleâcentre observational study of patients developing NOAF after cardiac surgery. The primary outcome is the description of NOAFâmaintaining structures within the atria. Key secondary outcomes include overall mortality, intensive care unit length of stay, hospitalâventilatorâfree days, and proportion of persistent NOAF. In NOAF patients, the nonâinvasive electrophysiological mapping will be conducted using a 252âelectrode electrocardiogram vest. After mapping, a lowâdose computed tomography scan of the chest will be performed to integrate the electrophysiological mapping results into a 3D picture of the heart. The study will include approximately 570 patients, of whom 30% (n = 170) are expected to develop NOAF. Sample size calculation revealed that 157 NOAF patients are necessary to assess the primary outcome. Patients will be tracked for a total of 5 years. Conclusions This is the largest prospective study to date describing the electrophysiological mechanisms of NOAF using nonâinvasive mapping