Clinical Outcomes in Patients with Pulmonary Hypertension Undergoing Total Hip Arthroplasty

Background

Pulmonary hypertension (PH) is regarded as a risk factor for perioperative complications in patients undergoing noncardiac surgery.

Questions/Purposes

The objective of this retrospective case–control study was to evaluate the adverse outcomes of pulmonary hypertension patients undergoing elective unilateral hip replacements.

Methods

We performed a retrospective case–control study of total hip replacement patients with pulmonary hypertension (cases) and without pulmonary hypertension (control). From the years 2003 to 2008, we identified a total of 132 patients undergoing primary total hip replacements with a diagnosis of pulmonary hypertension (right ventricular systolic pressure >35). The primary outcome assessed was the incidence of adverse events that occurred during the postoperative hospital stay. Secondary outcomes studied included length of hospital stay, mortality, and ability to reach certain physical therapy milestones.

Results

The PH group had significantly more adverse events than the control group. Nonlethal cardiac dysrhythmias comprised the most common adverse outcome among the PH group. Overall, the PH group had a morbidity rate of 34.7% while the control had a rate of 21%. The PH group had longer hospital stay (6.7 days vs. 5.9). Both groups had zero mortality during the hospital stay. The PH group had comparable rehabilitation recovery times than the control group.

Conclusion

This retrospective case–control study demonstrates that pulmonary hypertension patients undergoing total hip arthroplasty are more prone to adverse outcomes, especially cardiac dysrhythmias, and longer hospital stays.     

Measurement of Protein Synthetic Activity by Determination of Peptidyl[3H]puromycin Formation in Liver Slices after Ethanol Administration

We investigated the utility of [3H]puromycin as an alternate and adjunct precursor to amino acids for measuring protein synthetic activity in rat liver slices. Slices were incubated in the presence of either [3H]puromycin or radiolabeled valine to compare the incorporation of these isotopic precursors into nascent hepatocellular proteins. Compared to liver slices from controls, comparable decreases in the incorporation of both [3H]puromycin and labeled valine were observed in experiments using slices from fasted rats and in slices preincubated with 25 mM ethanol. Radiolabeling of nascent polypeptides with either [3H]puromycin or labeled valine in liver slices from rats fed a liquid diet containing ethanol was also decreased compared to slices from pair-fed control and chow-fed animals. Our results demonstrated the validity of using [3H]puromycin to detect changes in protein synthetic activity under these conditions. The potential advantage of using [3H]puromycin for in vivo studies is discussed.     

Effects of Ethanol on Reproduction and Arterial Hypertension in Spontaneously Hypertensive and Normotensive Rats: a Preliminary Communication

Ethanol consumption and spontaneous (essential) hypertension are important fetal and maternal risk factors. Alone, they contribute to embryopathy (fetal alcohol syndrome) or maternal organ pathology and fetal loss in hypertensive pregnancies. Combined, the effects of ethanol consumption on the progress of a hypertensive pregnancy have not been adequately investigated. In the present study, groups of O-A strain genetic hypertensive (SHR: groups 1 and 2) and Wistar-Kyoto normotensive (WKY: groups 3 and 4) pregnant rats were given 20 ml/kg of distilled water by gavage to serve as controls [groups 1 (SHR) and 3 (WKY)] or 3.2 g/kg of ethanol [groups 2 (SHR) and 4 (WKY)] from days 6 to 15 of gestation. During acclimation, hypertension developed in SHR rats (WKY pressures were 105 to 114 mm Hg; SHR pressures were 137 to 148 mm Hg). From day 6 to 15 of gestation, ethanol-consuming rats (groups 2 and 4) had higher arterial pressures than controls (groups 1 and 3). Pregnant SHR rats given ethanol did not experience a prebirthing hypotension. On gestation day 20, most offspring (84%, group 2; 86%, group 4) of alcoholic dams were dead or malformed. Intrauterine growth retardation occurred in group 4. Hydrocephalus, microphthalmia, and mild hydronephrosis and hydroureter were common in live offspring of group 2 dams. Hydronephrosis and hydroureter were increased in group 4 pups. Variant cranial ossification was noted in group 2 and 4 pups. These preliminary data suggest an altered hypertensive response during pregnancy in alcohol-consuming rats and confirm the embryopathic effects of relatively high levels of ethanol consumed during the critical period of organogenesis in two additional strains of rats.     

Limited M1 Disease: A Significant Prognostic Factor for Stage IV Breast Cancer

Purpose

The prognosis of patients with breast cancer presenting with distant metastasis can vary depending on disease extent. This study evaluates a definition of limited M1 disease in association with survival in a cohort of women presenting with metastatic breast cancer.

Methods

The study cohort comprised 692 women referred to the BC Cancer Agency between 1996 and 2005 with M1 breast cancer at presentation. Limited M1 disease was defined as <5 metastatic lesions confined to one anatomic subsite. Extensive M1 disease was defined as ??5 lesions or disease in more than one subsite. Clinicopathologic and treatment characteristics and overall survival (OS) were compared between subjects with limited (n?=?233) versus extensive (n?=?459) M1 disease. Multivariable analysis was performed by Cox regression modeling.

Results

Median follow-up time was 1.9?years. Five-year Kaplan-Meier OS was significantly higher in patients with limited compared to extensive M1 disease (29.7 vs. 13.1?%, p?p?Conclusions Limited M1 disease, defined as <5 metastatic lesions confined to one anatomic subsite, is a relevant favorable prognostic factor in patients with stage IV breast cancer. This definition may be used in conjunction with other clinicopathologic factors to select patients for more aggressive systemic and locoregional treatments.     

Health-related quality of life in hospital inpatients with pressure ulceration: Assessment using generic health-related quality of life measures

The objective of this study was to determine the impact of pressure ulceration on health-related quality of life (HRQoL) and to undertake a pilot study for a future larger study. The study comprised two parts. First, data from a large UK prospective cohort study were analyzed and the HRQoL of 218 people with pressure ulcers was compared with that of 2,289 people without ulcers using the Short Form-36 (SF-36) questionnaire. After adjusting for age, sex, and comorbidities, patients with pressure ulceration had significantly lower scores for both the physical (coefficient=−3.12, p <0.001) and mental (coefficient=−1.50, p =0.04) component summary scores of the SF-36. Second, a small pilot study was conducted to explore use of other tools. HRQoL was assessed in six patients with and 16 patients without pressure ulcers using the SF-36, the EQ-5D and a pain visual analog scale. SF-36 scores indicated that patients with pressure ulcers had significantly poorer physical functioning ( d =22.3, p =0.001), role limitations due to physical problems ( d =12.9, p =0.02), and vitality ( d =20.6, p =0.04) than those without. EQ-5D scores were also poorer for patients with pressure ulceration, for both the visual analog scale ( d =19.2, p =0.02) and the index ( d =0.29, p =0.08). Patients with pressure ulceration had more perceived pain than those without; however, this difference was of borderline significance ( d =−23.9, p =0.06). Pressure ulceration therefore has an impact on HRQoL that is measurable and persists after adjusting for potential confounding.     

LRP16反馈增强ERα介导转录激活活性的研究

目的:探讨LRP16对雌激素受体α(ERα)介导转录激活活性的反馈增强作用.方法:ERα模式启动子调控的荧光素酶报告子(3×ERE-Luc)或GC富含的ER反应性LRP16启动子S10(-101bp到-14 bp)调控的荧光素酶报告子(pGL-3-S10)与雌激素受体α(ERα)真核表达载体、LRP16真核表达载体(pcDNA3.1-16)共转染MCF-7细胞,测定3×ERE-Luc和pGL-3-S10的相对荧光素酶活性;3×ERE-Luc或pGL-3-S10与ERα真核表达载体、针对LRP16的小干扰RNA(LRP16-siRNA374、LRP16-siRNA668)或对照小干扰RNA(control-siRNA)共转染MCF-7细胞,测定3×ERE-Luc和pGL-3-S10的相对荧光素酶活性.结果:LRP16增强3×ERE-Luc和pGL-3-S10的相对荧光素活性,抑制LRP16表达显著削弱了3×ERE-Luc和pGL-3-S10的相对荧光素活性,并呈现剂量依赖性,该效应依赖于雌激素对ERα的激活.结论:ERα调控的靶基因LRP16反馈增强ERα介导的转录激活活性,是ERα的一个共激活因子.     

高频电场中金属植入物对周围组织影响的实验研究

目的探讨超短波治疗是否会造成动物体内钢板内固定部位周围组织温度的变化,继而造成热损伤,为临床应用提供依据。方法采用同一只兔左右肱骨对照方式,对照组暴露兔左侧上臂肱骨后即时用荧光光纤测温仪记录温热量超短波治疗时肱骨表面的温度变化,采集数据,在肱骨中央位置制造骨折模型,未植入钢板钢钉,术后连续15d温热量超短波治疗;实验组暴露兔右侧上臂肱骨,在肱骨表面植入钢板钢钉后即时用荧光光纤测温仪记录温热量超短波治疗时肱骨表面的温度变化,采集数据,在肱骨中央位置制造骨折模型(已植入钢板钢钉),术后连续15d温热量超短波治疗。15d后取两组骨折周围骨组织、肌肉及神经做病理。结果两组之间温度变化有显著差异(P<0.05)。实验组的温度变化最大为1.25℃,对照组的温度变化最大为1.2℃。病理显示两组骨折周围骨组织均可见未成熟的骨小梁和骨母细胞,纤维修复正在进行,未见明显炎性反应,神经及其周围组织未见异常。结论在本实验条件下,超短波可以安全应用于体内有金属的部位。