Risk factors for morbidity and mortality in mitral valve replacement

Risk factors of operative mortality and long term survival were identified in 219 patients who underwent mitral valve replacement (MVR) using Bj?rk-Shiley mechanical prostheses. Early mortality was 7.3%. The accumulated follow-up time was 1134 patient-years, and the 5-year survival for the total cohort was 78 +/- 3%. Independent prognostic factors of early mortality were poor NYHA class, which carried a relative risk (RR) of 3.2, and ischaemic aetiology, with a RR of 2.2. Ischaemic aetiology was the sole predictor of heart pump failure requiring intra-aortic balloon pump support (RR = 2.7). Independent risk factors of total mortality (early and late) were male sex (RR = 2.3), NYHA class III-IV (RR = 2.4), presence of mitral regurgitation (RR = 3.2) and relative heart volume (RR = 1.6 for a 800 ml/m2 size compared to a heart of 550 ml/m2). Our results underline the importance of patient-related factors in MVR, and indicate that care is needed in comparing the quality of MVR from different institutions with respect to mortality and morbidity. The results of MVR are palliative rather than curative except in female patients with NYHA class II function and mitral stenosis, in whom cure was attained.     

Evaluating Ga-68 Peptide Conjugates for Targeting VPAC Receptors: Stability and Pharmacokinetics

Molecular Imaging and Biology - In recent years, considerable progress has been made in the use of gallium-68 labeled receptor-specific peptides for imaging oncologic diseases. The objective was to...     

Improving women's quality of care for cardiovascular disease and diabetes: the feasibility and desirability of stratified reporting of objective performance measures.

Despite growing recognition of significant morbidity and mortality among women from cardiovascular disease, management of primary and secondary cardiac risk factors continues to be suboptimal for many women. Although there is a good deal of room to improve the care for cardiovascular disease and diabetes in men, existing gender differences in performance suggest much can be gained by specifically assessing and monitoring quality of care for these conditions in women. In this paper, we describe recent work showing gender differences in quality of ambulatory care in managed care plans with some plans having substantial gender differences on widely used measures of the quality of primary and secondary prevention of cardiac disease. We then discuss potential benefits of and barriers to routine reporting of objective measures of the quality of care, such as Health Plan Employer Data and Information Set (HEDIS) measures, by health plans.     

Hemodynamic and Metabolic Effects of Ketamine Anesthesia in the Geriatric Patient

The cardiovascular and metabolic effects of ketamine as the sole anesthetic agent for surgical correction of fractured neck of femur were studied in eight spontaneously breathing geriatric patients (mean age 83 years) before premedication, at the end of operation, and 15 min and 2 h after the end of anesthesia. Arterial blood pressure, cardiac index, left ventricular stroke work index and oxygen consumption increased during anesthesia but had returned to preoperative levels 15 min after the end of anesthesia. Vascular resistance, heart rate and stroke volume index were not significantly changed. During anesthesia, arterial carbon dioxide tension increased whereas arterial pH and arterial BE decreased. The levels of glucose and lactate increased in both blood and skeletal muscle during anesthesia and remained elevated throughout the period studied but the lactate: pyruvate ratio was unchanged. High energy phosphagen levels in skeletal muscle did not change. Ketamine anesthesia in the spontaneously breathing geriatric patient induces cardiovascular stimulation and metabolic changes indicative of an increased sympathetic stimulation, whereas respiration is slightly depressed. The magnitude of these changes is, however, small and it thus seems that ketamine can be safely used as the sole anesthetic agent for hip fracture surgery in the average geriatric patient.     

Cardiovascular and Metabolic Effects of Halothane and Enflurane Anesthesia in the Geriatric Patient

The hemodynamic and metabolic effects of halothane and enflurane anesthesia during mechanical ventilation in geriatric patients (n = 16, mean age 83 years) with hip fractures were studied before premedication, at the end of operation and 15 min and 2 h after the end of anesthesia. During anesthesia and surgery. systolic arterial blood pressure (SAP), cardiac index (CI), left ventricular stroke work index (LVSWI) and oxygen consumption (V?O₂) decreased to a similar extent in both groups, while systemic vascular resistance index (SVRI) remained unchanged. Fifteen minutes after the end of anesthesia SAP, CI and LVSWI had returned to preoperative levels but SVRI was decreased in both groups. Pulmonary systolic and diastolic pressures were unchanged during anesthesia but slightly increased 15 min after the end of anesthesia. No change was seen in venous admixture. In the halothane group, a significant increase in V?O₂ occurred in the postanesthetic period due to shivering. During anesthesia and surgery, arterial oxygen tension and arterial pH increased but arterial carbon dioxide tension decreased in both groups due to hyperventilation with the oxygen-enriched gas mixture (N₂O:O₂ = 1:1). A similar increase in blood glucose, lactate and pyruvate levels was seen in both groups in the per- and postanesthetic periods, but there was no excess lactate production. In skeletal muscle, glucose and lactate levels were increased 15 min after the end of anesthesia but no changes were seen in the high energy phosphagen levels. It may thus be concluded that both halothane and enflurane had similar hemodynamic and metabolic effects in the geriatric patient. Both agents induced a myocardial depression and a decrease in whole body oxygen consumption. The effects on tissue metabolism were small and seem to be mainly due to an increased sympathetic activity caused by surgical stimuli.     

Sequence Specificity of Alternating Hydroyprolyl/phosphono Peptide Nucleic Acids against Zebrafish Embryo mRNAs

Morpholino phosphorodiamidate (MO) DNA mimics display excellent water solubility and hybridization properties toward DNA and RNA, and have been utilized in the model vertebrate zebrafish (Danio rerio) for genome-wide, sequence-based, reverse genetic screens during embryonic development. Peptide nucleic acids (PNAs) exhibit excellent mismatch discrimination, nuclease resistance, and protease resistance, but low solubility. Negatively charged DNA mimics composed of alternating residues of trans-4-hydroxy-L-proline peptide nucleic acid monomers and phosphono peptide nucleic acid monomers (HypNA-pPNA) combine all of the positive features of both MOs and PNAs. Thus, we evaluated PNA oligomers and HypNA-pPNA oligomers as an alternative to MOs for oligonucleotide inhibition of gene expression in zebrafish embryos. We observed that HypNA-pPNA 18-mers displayed comparable potency to MO 25-mers as knockdown agents against chordin, notail and uroD, with greater mismatch stringency. Furthermore, we observed that a specific HypNA-pPNA 18-mer elicited the dharma (bozozok)^-/- phenotype in zebrafish embryos, which MO 25-mers do not. These observations validate HypNA-pPNAs as an alternative to MO oligomers for reverse genetic studies. The stronger hybridization and greater specificity of HypNA-pPNAs enable knockdown of mRNAs unaffected by MO oligomers.