Circulating ionized calcium and parathyroid hormone levels following coronary artery by-pass surgery

In critically ill patients, hypocalcaemia is a common finding. Also variable derangements in the normally tight Ca2+-mediated control of the parathyroid hormone (PTH) secretion have been found. Utilizing coronary artery by-pass grafting (CABG) as a standardized model of severe trauma, 18 patients underwent determinations of blood levels of calcium, magnesium (Mg), ionized calcium (Ca2+), serum levels of intact PTH, procalcitonin (PCT) and the proinflammatory cytokines tumour necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). Samples were collected before, directly after, the morning after and 5 days after surgery. A significant, but minor, decrease in blood Ca2+ levels (mean 0.04 mmol/L, p<0.05) was seen shortly after CABG, not accompanied by any significant change of serum PTH levels. This alteration of the Ca2+ control of the steady-state PTH levels contrasted with the maintenance of the PTH secretory response to a sequential citrate and calcium infusion (CiCa clamp), which was normal in two patients evaluated in the morning following surgery. Serum Mg levels were transiently increased after operation (+0.25 mmol/L, p<0.001) and correlated to the TNF-alpha (r=0.62, p <0.01) and PCT (r=0.67, p < 0.006) levels in the morning after surgery. Serum levels of IL-6 and TNF-alpha were significantly (p < 0.0001) increased immediately after surgery, while the peak in serum PCT levels (p < 0.001) occurred in the morning after CABG. Serum PTH levels correlated positively with IL-6 (r=0.68, p<0.008) 5 days after surgery. In conclusion, CABG caused a decrease in ionized calcium levels without a rise in steady-state PTH levels, but rapid changes in Ca2+ during CiCa clamping revealed a normal PTH secretory response. These findings might relate to elevated serum Mg levels, while a direct action of TNF-alpha or IL-6 on the PTH release seem less possible.     

Significant peri-operative reduction in plasma osteopontin levels after coronary artery by-pass grafting

ObjectivesOsteopontin (OPN) is a multifunctional protein associated with vascular injury and has been linked to atherosclerosis and inflammation. We sought to investigate whether OPN changes in relation to coronary artery by-pass grafting (CABG) surgery.Design and methodsWe studied 50 consecutive patients (63 ± 10 years old, 6 women and 44 men) undergoing elective CABG. Plasma OPN levels were determined by an enzyme-linked immunosorbent assay at baseline and in 24 and 72 h, post-operatively. Cardiac enzymes — creatine kinase, the MB isoenzyme of creatine kinase, troponin-I- and C-reactive protein (CRP) were also determined at all three time points.ResultsOPN levels 72 h post-op decreased significantly compared to pre-op and 24 h post-op levels (p < 0.001) whereas there was no difference between the pre-op and first post-op values (p = 0.57). The relative change in OPN levels between pre-op and 72 h post-op correlated negatively with absolute troponin-I levels at 72 h post-op (? 0.51, p = 0.005). OPN levels 72 h post-op correlated significantly with CRP at baseline (r = 0.73, p = 0.002).ConclusionsOPN plasma concentrations decreased after CABG surgery in the early post-operative period. The significance of this observation needs further investigation.     

瑞芬太尼复合异丙酚对不停跳冠状动脉搭桥术中血液动力学的影响

目的 观察瑞芬太尼复合异丙酚对非体外循环冠状动脉搭桥手术患者术中血液动力学的影响以及术后恢复情况.方法 非体外循环冠状动脉搭桥手术患者20例,麻醉用依托咪脂0.2～0.3 mg/kg、咪唑安定0.1～0.2 mg/kg、瑞芬太尼2μg/kg诱导,术中用瑞芬太尼0.1～0.3μg/(kg·min)和异丙酚2～4 mg/(kg·h)维持,在术前、开心包后、搬动心脏操作中、术毕和拔管后观察血液动力学指标及混合静脉血氧饱和度,同时采集桡动脉和肺动脉血,测定血气;观察术后拔除气管插管、ICU停留及术后住院时间、并发症及死亡等情况.结果 患者术中血液动力学出现显著变化,心脏操作中平均动脉压(MAP)、心指数(CI)、左室每搏作功指数(LVSWI)、右室每搏作功指数(RVSWI)下降,心率(HR)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)升高(P<0.01);拔管时间(2.1±0.5)小时,ICU停留时间(1.8±0.7)天,术后住院时间(10.5±2.1)天;所有患者均无脑部并发症,1例出现房颤,无死亡病例.结论 术中用瑞芬太尼复合异丙酚麻醉能使患者安全度过非体外循环搭桥术,但在心脏操作期间易出现血压、每搏量、心指数下降,伴心率、静脉压升高,处理及时无严重后果.     

Serum lipid and lipoprotein levels in normal Chinese

Serum lipid and lipoprotein levels in normal healthy Chinese adults were determined. The average serum total lipid, cholesterol, triglyceride and phospholipid levels were 568 ± 96, 181 ± 34, 90 ± 35 and 181 ± 28 mg/100 ml, respectively. Serum cholesterol in Chinese appeared to be significantly lower than that in Caucasians. The possible cause of this difference is discussed in terms of variations of dietary intake between these ethnic groups.     

Serum lipid levels in hypertensive patients during captopril treatment

Captopril (37.5 mg daily) was administered to 64 hypertensive patients for 16 weeks. During treatment, systolic and diastolic blood pressures decreased significantly (from means of 164/98 mmHg before treatment to 150/90 mmHg at four weeks and 142/86 mmHg at eight weeks; P less than 0.001), but serum levels of total cholesterol, triglycerides, lipoprotein cholesterol, lipoprotein triglyceride, and apolipoproteins showed no significant changes. Scores on the atherogenic index did not change. Patients with high initial total cholesterol levels and low high-density lipoprotein cholesterol levels tended to improve their lipid levels. It is concluded that captopril does not adversely affect serum lipoprotein metabolism.     

Serum vitamin E,lipid peroxide and glutathione peroxidase in patients with chronic pancreatitis

It has been reported that lipid peroxidation increases in patients with antioxidant deficiencies, such as vitamin E and glutathione peroxidase. The relationships between serum lipid peroxide and vitamin E on the one hand and glutathione peroxidase on the other were examined in 22 patients with chronic pancreatitis, often accompanied by malabsorption of fats and fat-soluble vitamins due to the impaired exocrine pancreatic function.Both serum vitamin E concentrations and glutathione peroxidase activities were depressed, especially in patients with chronic calcifying pancreatitis. On the other hand, serum lipid peroxide levels were elevated. A significant negative correlation was found between the serum lipid peroxide levels and vitamin E concentration.These findings suggest that an elevation of the serum lipid peroxide level may be due to the lack of an antioxidative defense mechanism, such as vitamin E, against lipid peroxide.     

肝移植术后危重患者血浆脂质过氧化物的变化及意义

目的　研究肝移植患者术后血浆中脂质过氧化物 (L PO)与术后病情变化的关系。方法　测定了18例肝移植患者术后 2 1d内血浆中 L PO的水平 ,分析其与预后的关系。结果　血浆 L PO在病情明显恶化前有所升高 ,尤其在死亡组患者持续升高 ,其升高的峰值明显高于存活患者 ,血浆 L PO峰值超过 10 μmol/L 的患者死亡几率 (5 /6 )高于血浆 L PO峰值低于 10 μmol/L 的患者 (1/12 ) ,两组病死率差异有显著性意义(P<0 .0 1) ,血浆 L PO日变化率超过 1.2 μmol· L- 1· d- 1的患者死亡几率 (4/5 )高于血浆 L PO日变化率低于 1.2 μmol· L- 1· d- 1的患者 (2 /13) ,两组病死率差异有显著性意义 (P<0 .0 1)。结论　术后检测血浆 L PO对正确判断患者病情危重程度有重要的临床价值 ,可作为常规检查。     

Serum levels of lipid peroxidation products as markers of dyslipidemia disorders

The content of triglycerides (TG), total cholesterol (TC) and the level of 5 categories of lipid-peroxidation (LP) products were investigated in blood serum of 27 patients with atherogenic dislipidemic disorders. Multiple regression analysis was made for the dependence of the concentrations of TG and TC on a level of the LP circulating products. It was found that the parameters of the LP products' content in blood serum can be used to calculate the TG and TC concentrations, i.e. they are a system of indirect markers of a pronouncement degree of dislipidemic disorders.     

2013年安徽省成年人血脂水平和血脂异常分布特征分析

目的 了解安徽省成年人血脂异常流行水平,为制定血脂异常防治卫生政策提供依据。方法 利用2013年中国成年人慢性病及其危险因素监测项目中安徽省的调查数据,采用多阶段整群随机抽样方法,以面对面询问方式收集调查对象的相关信息,采集空腹静脉血,测定血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）,并使用事后分层权重调整和复杂抽样设计方法进行统计分析。结果 有效样本量为7120人,成年人血脂异常患病率为29.56%,其中男性为34.91%,女性为24.26%,男性血脂异常率随年龄增加而降低（2=13.907,P=0.000）,女性则随年龄增加而增加（2=73.366,P=0.000）。血清TC、TG、HDL-C和LDL-C水平分别为4.53、1.43、2.73和1.39 mmol/L,男性血清TG和HDL-C水平与文化程度分别呈正相关和负相关（t=5.938,P=0.000;t=-12.641,P=0.000）,女性血清TC、TG和LDL-C水平均随年龄增长而增加（t=10.060,P=0.000;t=12.531,P=0.000;t=8.058,P=0.000）,不同职业间4种指标差异均有统计学意义。高TC血症、高TG血症、高LDL-C血症和低HDL-C血症患病率分别为5.14%、12.36%、5.18%和16.94%,高TC、高LDL-C和低HDL-C血症患病率随年龄增加而升高（2=13.631,P=0.000;2=14.684,P=0.000;2=8.893,P=0.003）,男性高TG和低HDL-C血症患病率与文化程度呈正相关（2=40.386,P=0.000;2=70.480,P=0.000）,不同职业间的高LDL-C血症和低HDL-C血症患病率差异有统计学意义（2=28.783,P=0.000;2=14.687,P=0.040）。结论 血脂异常是安徽省成年人居民中常见的健康危险因素,应根据血脂异常的年龄、性别、文化程度和职业等差异实施针对性的防控措施。     

老年睡眠期周期性腿动患者的血脂水平分析

目的研究老年睡眠期周期性腿动(PLMS)患者的血脂水平改变。方法采用微动敏感床垫睡眠监测系统检测60岁以上老年住院心血管病患者睡眠呼吸暂停低通气综合征(SAHS)和PLMS,调查患者心血管疾病及等危症、服用他汀类药物情况,检测血脂成分并分析。结果 104例SAHS患者进入本研究,平均年龄(76.6±6.7)岁,PLMS患者46例。在患者年龄、性别、患心血管疾病和(或)糖代谢异常、服用他汀类药物病例数和睡眠呼吸紊乱参数、夜间血氧水平相近的情况下,PLMS组血清总胆固醇水平显著低于非PLMS组[(4.46±0.88)mmol/L比(4.84±0.94)mmol/L,P0.05]。结论老年PLMS患者血清总胆固醇水平较非PLMS患者低,这种血清总胆固醇的降低可能具有一定的临床意义。     

Serum levels of gastric-acid-stimulating factors in children undergoing open heart surgery

Purpose  Upper gastrointestinal (GI) bleeding is a feared consequence of open heart surgery in children. Increased gastric acid secretion is a known key factor in the pathogenesis of gastritis and upper intestinal ulcerations. The aim of this study is to evaluate the serum kinetics of acid-stimulating factors and associated perioperative parameters after heart surgery in children. Methods  Fifteen pediatric patients after open heart surgery and 15 children with cardiac catheterization were included in this study. Serum levels of gastrin, histidine, alanine, and tryptophan were analyzed before and up to 26 h after surgery. Results  In the postoperative period there was a significant elevation of gastrin with a peak at 4 h after surgery. Serum histidine was increased significantly immediately after surgery only in patients undergoing heart surgery with cardioplegia. No association of gastrin and histidine elevation with ischemia, perfusion time or lactate was observed. Conclusion  Factors that are responsible for postoperative gastrin elevation still have to be determined. Circumstances of extracorporeal circulation (ECC) in low-risk patients most likely do not lead to relevant elevation of amino acids with acid-stimulatory effect in our study population.     

Serum uric acid and lipid levels while taking topiramate for migraine

Objective.— Topiramate (TPM) therapies for epilepsy or migraine are long-time therapies with unknown mechanisms and special side effects. TPM influences cholesterol (TC) and lipoprotein serum levels. In addition, TPM may cause uric acid (UA) stone formation.
Material and Methods.— Serum UA, TC, and triglyceride (TG) levels were measured in 53 migraine patients receiving TPM and in 44 age- and sex-matched controls. Compared with controls, patients on TPM showed significantly higher UA and nonsignificantly higher TC and TG values. We recorded pre- and posttreatment levels of UA, TC, and TG levels in 23 patients.
Results.— We found increased serum levels of UA with TPM use ( P  < .01). There was a significant and positive correlation between serum UA levels and male gender ( P  < .01).The changes in serum UA levels before and after TPM treatment differed significantly ( P  < .01).
Conclusion.— Our results suggest a need for monitoring serum UA levels in patients receiving TPM. We should perhaps prescribe a low-UA diet and advice to drink much more water in these patients.     

Monitoring of myocardium state during off-pump coronary artery by-pass grafting

A measurement technique for evaluation of processes occurring in the myocardium during blood flow arrest is presented. The system is devoted to monitoring the myocardium state during off-pump coronary artery by-pass grafting, i.e. during a surgical operation performed on a beating heart. A substantial part of the system is a probe whose construction is similar to a mechanical stabilizer. Such a stabilizer is used for preventing the myocardium from moving, thus it enables stitching of the graft and artery. In comparison to the commercially available stabilizer the developed probe is enhanced with a set of electrodes. These electrodes enable simultaneous measurements of impedance and electrograms. Examples of recordings made during in vivo studies are also presented. Thus, the proposed method is applicable and potentially very useful in clinical practice.     

Serum lipid levels and 3-month prognosis in Chinese patients with acute stroke

INTRODUCTION: The possible correlation between serum lipid levels and outcome after stroke is still controversial. Therefore we examined whether serum lipid levels at admission had any prognostic value in the 3-month outcome after stroke. METHODS: We performed a prospective, observational study of 649 patients with acute ischaemic stroke and intracerebral haemorrhagic stroke (ICH). Information on age, sex, history of arterial hypertension, diabetes mellitus, drinking, current smoking status, stroke type, Glasgow Coma Scale and Scandinavian Stroke Scale score, time from stroke onset, and presence of atrial fibrillation was obtained. Serum lipid levels were measured in blood samples taken from fasting patients 12 to 48 hours following ictus. Death and poor neurological outcome (Modified Rankin Scale score of >/=3 points) were defined as outcome events. A logistic regression model was performed to estimate the effect of the above variables on outcome after stroke. RESULTS: We found that the median levels of serum total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) in good outcome patients with acute stroke were significantly higher (P<0.005) than those of poor outcome patients. The low levels of serum TC, TG and HDL-C (P<0.05) were independently related to increased 3-month poor outcome after acute ischaemic stroke and ICH. However, there was no significant relationship between LDL-C levels and 3-month outcome. CONCLUSION: The data from this study show that low levels of serum TC, TG and HDL-C are strong independent predictors of 3-month poor outcome in patients with acute ischaemic stroke and ICH.     

Serum cardiac troponin I after conventional and minimal invasive coronary artery bypass surgery.

We evaluated myocardial release of cardiac troponin I (cTnI) in patients treated with conventional coronary artery bypass grafting (CABG), which employs extracorporeal circulation, and different kinds of minimal invasive coronary artery bypass grafting (MICABG), a surgical technique where the operation is performed without extra-corporeal circulation. Furthermore, we evaluated the usefulness of serum cTnI measurement to detect perioperative myocardial infarction (PMI) after coronary artery bypass surgery. Thirty-one patients were included: sixteen underwent CABG, fifteen underwent different MICABG and five patients had PMI. Blood specimens for cTnI measurements were collected up to 72 hours after opening the graft. Aortic cross-clamping time was a minor determinant of myocardial damage; on the other side, the trauma during surgery correlated with the number of involved arteries and with the manoeuvre employed to obtain heart dislocation, and appeared a more important determinant of myocardial damage. In patients with PMI, the cumulative release of cTnI was higher than in patients free from PMI; however, only after 24-72 hours we observed significant differences in serum cTnI values, because the increased perioperative values of cTnI complicated the interpretation of the myocardial status and a single cut-off could not be used to exclude PMI.