Glycocalyx Degradation and Inflammation in Cardiac Surgery

Objective: Experimental inflammation induces degradation of glycocalyx. The authors hypothesized that inflammation is an important determinant of glycocalyx degradation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Design: A prospective observational study. Setting: Operation theater and intensive care unit of a university hospital. Participants: Two separate prospective patient cohorts. Interventions: Blood samples were collected at 5 perioperative time points in the trial cohort (30 patients) and only preoperatively in the preoperative cohort (35 patients). Plasma syndecan-1 (biomarker of glycocalyx degradation), interleukin-6 (IL-6), IL-8, and IL-10 were measured. Measurements and Main Results: In the trial cohort, preoperative ranges were as follows: 0.8-198 ng/mL for syndecan-1; 0-902 pg/mL for IL-6; 0-314.9 pg/mL for IL-8, and 0-2,909 pg/mL for IL-10. Seven out of 30 patients were outliers in terms of plasma concentrations of syndecan-1 and all cytokines preoperatively. The increase of syndecan-1 was 2.7-fold, and those of IL-6 and IL-8 were both 2.5-fold. The increase of IL-10 was modest. Plasma syndecan-1 correlated with all cytokines preoperatively (IL-6: R = 0.66, p <0.001; IL-8: R = 0.67, p = 0.001; IL-10: R = 0.73, p <0.001) as well as at 6 hours postoperatively (IL-6: R = 0.49, p = 0.006; IL-8: R = 0.43, p = 0.02; IL-10: R = 0.41, p = 0.03) and on the postoperative morning (IL-6: R = 0.57, p = 0.001; IL-8: R = 0.37, p = 0.06; IL-10: R = 0.51, p = 0.005) but not intraoperatively. The preoperative findings of the trial cohort could be confirmed in the preoperative cohort. Conclusions: In patients undergoing cardiac surgery with CPB, inflammation in terms of proinflammatory cytokines IL-6 and IL-8 and anti-inflammatory cytokine IL-10 is associated with glycocalyx degradation measured as plasma syndecan-1 concentrations. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe

Perioperative Myocardial Infarction in Non-Cardiac Surgery Patients : A Prospective Observational Study

Background and Aims: Perioperative myocardial infarction is an underdiagnosed complication causing morbidity, mortality, and considerable costs. However, evidence of preventive and therapeutic options is scarce. We investigated the incidence and outcome of perioperative myocardial infarction in non-cardiac surgery patients in order to define a target population for future interventional trials. Material and Methods: We conducted a prospective single-center study on non-cardiac surgery patients aged 50years or older. High-sensitivity troponin T and electrocardiograph were obtained five times perioperatively. Perioperative myocardial infarction diagnosis required a significant troponin T release and an ischemic sign or symptom. Perioperative risk calculator was used for risk assessment. Results: Of 385 patients with systematic ischemia screening, 27 patients (7.0%) had perioperative myocardial infarction. The incidence was highest in vascular surgery19 of 172 patients (11.0%). The 90-day mortality was 29.6% in patients with perioperative myocardial infarction and 5.6% in non-perioperative myocardial infarction patients (p Conclusion: Perioperative myocardial infarction is a common complication associated with a 90-day mortality of 30%. The ability of the perioperative risk calculator to predict perioperative myocardial infarction was fair supporting its routine use.Peer reviewe

Taloudelliset ohjauskeinot kiertotalouden arvoketjuissa

Luonnonvarojen yhä kiihtyvä käyttö on johtanut monenlaisiin ympäristöhaasteisiin. Tilanteen kärjistymisen syynä nähdään pitkälti vallalla oleva nykyinen ota, valmista, hävitä -talousjärjestelmä, joka perustuu helposti saatavilla olevien ja edullisten materiaalien ja energian mittavaan käyttöön. Poliittisessa ja tieteellisessä keskustelussa korostetaan tarvetta siirtyä kiertotalouteen, jossa raaka-aineita, materiaaleja ja tuotteita kierrätetään ja uudelleenkäytetään mahdollisimman kauan.Kiertotalouden taloudelliset ohjauskeinot (KIMAT) –hankkeessa on tarkasteltu, miten taloudellisin ohjauskeinoin voidaan edesauttaa kiertotalouden kehitystä Suomen kannalta keskeisessä arvoketjussa. Hankkeessa on kartoitettu mahdollisia taloudellisia ohjauskeinoja Suomesta ja kansainvälisesti, hankittu tietoa arvoketjujen kiertotalouspotentiaalista ja mahdollisista kiertotaloustoimista, kartoitettu ohjauskeinojen kehitystarpeita yrityshaastattelujen kautta ja mallinnettu arvoketjujen mahdollisuuksia Suomen kansantalouden tasolla.Kiertotalouden perittaatteita ja toimintatapoja on jo monelta osin toteutettu Suomessa. Kiertotaloudessa taloudellinen potentiaali jakautuu usein ohuisiin virtoihin ja varantoihin, ja ohjauksen haaste on löytää keinoja niiden hyödyntämiseen. Isot volyymit eivät yksinään riitä muodostamaan taloudellista potentiaalia. Tarvitaan myös lisäarvoa. Tähän voidaan vaikuttaa taloudellisin ohjauskeinoin. Nykyiset ohjauskeinot ovat monella alueella tehokkaita, mutta lisätoimia tarvittaisiin erityisesti tuotteiden pitämiseksi kierrossa mahdollisimman pitkään mm. ylläpidon, uudelleenkäytön ja uudelleenvalmistuksen keinoin. Lisäksi kiristyvät odotukset ja poliittiset tavoitteet haastavat kehittämään niitä uudelle tasolle. Taloudellisen ohjauksen rinnalla tarvitaan myös muunlaista ohjausta

Levosimendan : molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan

The molecular background of the Ca2+-sensitizing effect of levosimendan relates to its specific interaction with the Ca2+-sensor troponin C molecule in the cardiac myofilaments. Over the years, significant preclinical and clinical evidence has accumulated and revealed a variety of beneficial pleiotropic effects of levosimendan and of its long-lived metabolite, OR-1896. First of all, activation of ATP-sensitive sarcolemmal K+ channels of smooth muscle cells appears as a powerful vasodilator mechanism. Additionally, activation of ATP-sensitive K+ channels in the mitochondria potentially extends the range of cellular actions towards the modulation of mitochondrial ATP production and implicates a pharmacological mechanism for cardioprotection. Finally, it has become evident, that levosimendan possesses an isoform-selective phosphodiesterase-inhibitory effect. Interpretation of the complex mechanism of levosimendan action requires that all potential pharmacological interactions are analyzed carefully in the framework of the currently available evidence. These data indicate that the cardiovascular effects of levosimendan are exerted via more than an isolated drug-receptor interaction, and involve favorable energetic and neurohormonal changes that are unique in comparison to other types of inodilators. (C) 2011 Elsevier Ireland Ltd. All rights reserved