Estimated creatinine clearance instead of plasma creatinine level as prognostic test for postoperative renal function in patients undergoing coronary artery bypass surgery.

Contains fulltext : 49954.pdf (publisher's version ) (Closed access)BACKGROUND: Preoperative renal failure is a risk factor for adverse events in cardiac surgery. Serum creatinine (SCr) is the most used test for renal failure. However, patients can have significantly decreased glomerular filtration rates with normal SCr levels. More accurate approximation of renal function can be obtained using the Cockroft-Gault equation to calculate an estimated creatinine clearance (CrCl) rate from SCr. METHODS: This study included 627 patients undergoing an isolated CABG between January 2003 and September 2004. CrCl was calculated using the Cockroft-Gault formula. Patients were divided in group A-SCr, 576 patients (91.1%) with a good renal function, SCr < or =1.20 mg/dL for women and < or =1.40 mg/dL for men, and a group B-SCr, with impaired renal function, 51 patients (8.1%). CrCl < or = 50 mL/min was chosen to reflect renal impairment. Group A-CrCl (555 patients, 88.5%) had a normal renal function and group B-CrCl (72 patients,11.5%) an impaired renal function. The studied outcomes were hospital mortality, hospital morbidity, and postoperative renal failure. RESULTS: There was no statistical significant difference between A-SCr and B-SCr group according to the studied outcomes. On the contrary, using the CrCl there was a statistical significant difference between A-CrCl and B-CrCl for the percentage of postoperative renal failure 10 patients (1.8%) versus 5 patients (6.9%) (p=0.00), hospital morbidity 75 patients (13.5%) versus 16 patients (22.2%) (p=0.04). Hospital mortality, 11 patients (2%) versus 4 patients (5.6%), was not significantly (p=0.06) different. Postoperative dialysis, four patients (0.7%) versus three patients (4.2%) (p=0.00), stroke, three patients (0.5%) versus three patients (4.2%) (p=0.00), and hospital stay (7.6 days vs 11.0 days) (p=0.01) were significantly different. CONCLUSION: This study documents that the association between preoperative renal failure and adverse outcomes after CABG is stronger with the estimated CrCl than with the routinely used SCr. Routine estimation or measurement of glomerular filtration rate should be preferred to SCr as screening method for the detection of higher risk patients undergoing CABG

Atrial fibrilation: the relation between heart and brain.

Contains fulltext : 50799.pdf (publisher's version ) (Closed access

Magnetoresistance of Si/Nb/Si Trilayers

We study the superconductor-insulator transition in Si/Nb/Si trilayers, in which the thickness of Si is fixed at 10 nm, and the nominal thickness of Nb changes in the range between d = 20 nm down to d = 0.3 nm. The transmission electron microscopy indicates the formation of the mixed Nb-Si layer for small d. Both the thickness-induced, and the magnetic-field induced superconductor-insulator transition is observed. The crossing point of the isotherms at the critical field $B_{c}$ decreases with decreasing d, and it is T-independent at temperatures below 300 mK. At larger fields the weak peak in magnetoresistance appears in some of the films

The relationship between atrial fibrillation, neurocognitive deficits and depression

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Persisting thrombin activity in elderly patients with atrial fibrillation on oral anticoagulation is decreased by anti-inflammatory therapy with intensive cholesterol-lowering treatment

Item does not contain fulltextBACKGROUND: It has been demonstrated that the occurrence of ischemic stroke is more prevalent in AF patients, when increased levels of inflammatory markers are present. OBJECTIVE: The aim of this study was to evaluate the effect of intensive cholesterol lowering therapy on inflammatory markers and evidence of thrombotic in elderly AF patients treated with OAC. METHODS: 34 elderly patients (69-85 yrs) were randomized to double blind treatment with atorvastatin 40 mg plus ezetimibe 10 mg (n = 17) or double placebo (n = 17) for one year. All were anticoagulated with warfarin (target INR 2.5-3.5). Every 3 months inflammatory markers and parameters for evaluation of haemostatic and fibrinolytic activity were measured. RESULTS: Anti-inflammatory effects in the treatment arm were reflected by a significant decrease from baseline in hs-CRP, FGF, G-CSF, GM-CSF, IL-1ra, IL-9, IL-13, IL-17 and interferon-gamma (P < .05). There was no significant decrease in the control group. Endogenous thrombin potential was still present and active but decreased during treatment (P = .0005) compared to the placebo group. After 12 months treatment, a significant correlation was found between changes in endogenous thrombin potential and hs-CRP, interferon-gamma and G-CSF, respectively. No hemorrhagic complications occurred. CONCLUSION: Intensive cholesterol lowering significantly reduced inflammation and was accompanied by reduced thrombin generation. Larger clinical studies should determine which inflammatory markers are most specific and sensitive for estimating the inflammatory burden in these patients and at which corresponding thrombin activity level it is beneficial and safe to add intensive cholesterol lowering therapy even if normal cholesterol levels are present