Predictive factors of hemodynamic collapse after coronary artery bypass grafting: a case-control study

OBJECTIVE: Sudden hemodynamic collapse after coronary artery bypass graft (CABG) surgery is a complication with high morbidity and mortality. The aim of this study was to explore factors possibly predictive of this major complication. DESIGN: Retrospective case-control study. SETTING: University hospital, department of cardiothoracic surgery. PARTICIPANTS: Between 1988 and 1999, of 8,807 CABG patients, a total of 76 (0.9%) suffered hemodynamic collapse after CABG surgery unrelated to pericardial tamponade or bleeding. Preoperatively matched patients (by age, sex, New York Heart Association classification, number of diseased vessels, left ventricular ejection fraction, and diabetes) served as a control group (n = 76). INTERVENTIONS: Patients with sudden cardiovascular collapse underwent emergency reopening of the sternotomy and open cardiac massage (OCM group). Several pre-, intra-, and postoperative variables were compared, and significant parameters in match-pair analysis were further tested with regression techniques. MEASUREMENTS AND MAIN RESULTS: Of the 76 OCMs, 57 (75%) occurred during the first 5 postoperative hours. In-hospital mortality was 46% (35 of 76) versus 0% in controls; 5-year survival was 49% versus 95%. In the OCM group, cardiopulmonary bypass (CPB) time was significantly prolonged (p = 0.0024), and cardiac index (p = 0.05) and the first acid-base values after CPB were lower (pH, p = 0.0057; BE, p = 0.0014). Postoperative myocardial ischemia appeared in 33% of patients in the OCM group and in 8% of controls (p < 0.0001). OCM-group patients more frequently required postoperative inotropic (epinephrine, p = 0.0002) and mechanical support (intra-aortic balloon pump, p = 0.005). Regression analysis revealed a correlation between cardiopulmonary resuscitation risk and low cardiac index, postoperative ischemia, and low pH level. CONCLUSION: Inadequate tissue perfusion, postoperative myocardial ischemia, and increased need for inotropic and mechanical support preceded hemodynamic collapse. Interventions to improve tissue perfusion and to prevent and treat myocardial ischemia may result in a more favorable outcome.     

Students’ Perceptions of Motivational Climate and Enjoyment in Finnish Physical Education: A Latent Profile Analysis

The purpose of this study was to identify student clusters with homogenous profiles in perceptions of task- and ego-involving, autonomy, and social relatedness supporting motivational climate in school physical education. Additionally, we investigated whether different motivational climate groups differed in their enjoyment in PE. Participants of the study were 2 594 girls and 1 803 boys, aged 14-15 years. Students responded to questionnaires assessing their perception of motivational climate and enjoyment in physical education. Latent profile analyses produced a five-cluster solution labeled 1) ‘low autonomy, relatedness, task, and moderate ego climate’ group’, 2) ‘low autonomy, relatedness, and high task and ego climate, 3) ‘moderate autonomy, relatedness, task and ego climate’ group 4) ‘high autonomy, relatedness, task, and moderate ego climate’ group, and 5) ‘high relatedness and task but moderate autonomy and ego climate’ group. Analyses of variance showed that students in clusters 4 and 5 perceived the highest level of enjoyment whereas students in cluster 1 experienced the lowest level of enjoyment. The results showed that the students’ perceptions of various motivational climates created differential levels of enjoyment in PE classes.

Key points

• Latent profile analyses produced a five-cluster solution labeled 1) ‘low autonomy, relatedness, task, and moderate ego climate’ group’, 2) ‘low autonomy, relatedness, and high task and ego climate, 3) ‘moderate autonomy, relatedness, task and ego climate’ group 4) ‘high autonomy, relatedness, task, and moderate ego climate’ group, and 5) ‘high relatedness and task but moderate autonomy and ego climate’ group.
• Analyses of variance showed that clusters 4 and 5 perceived the highest level of enjoyment whereas cluster 1 experienced the lowest level of enjoyment. The results showed that the students’ perceptions of motivational climate create differential levels of enjoyment in PE classes.

Key words: Motivational climate, enjoyment, physical education, clusters     

Prolonged bihemispheric alterations in unfolded protein response related gene expression after experimental stroke

After ischemia, endoplasmic reticulum (ER) stress pathways are activated that include unfolded protein response (UPR) and protein synthesis inhibition (PSI). Both of these mechanisms aim to restore ER functioning mainly by inhibition of translation and increased processing of excess proteins in ER. We were interested in the role of these pathways during spontaneous recovery after transient middle cerebral artery occlusion (MCAO) in rats. The spontaneous recovery of rats was assessed with a limb-placing test. The expression of ER-stress-related genes (IRE1, ATF6, GRP78, eif2alpha, ATF4, PERK) was studied by using in situ hybridization in different brain areas on post-operative days 2, 7, 14 and 28. Elevated signals were detected in striatum contralateral to the lesion on days 2 (PERK and IRE1) and 14 post-ischemia (IRE1). Gene expression was elevated on day 7 in the striatum ipsilateral to the lesion (ATF6 and GRP78) and on day 14 (GRP78) post-ischemia. Furthermore, elevated levels of GRP78 were detected on day 14 after ischemia in the ipsilateral sensorimotor cortex. These results suggest that altered gene expression related to unfolded protein response may be more long lasting than expected following focal cerebral ischemia. In addition, these results show that the response to ER stress differs ipsi- and contralaterally after MCAO in rats. Since these differences are detected in both hemispheres only in areas adjacent to the lesion, UPR may contribute to spontaneous recovery after MCAO in rats.     

Reactions and Attitudes to Postpartal Mental Symptoms in a Rural Community

We examined the reactions of population, social and health care professionals and local politicians in the context of a narrative case of a newborn and her mother evincing postpartal mental symptoms. The results of this postal questionnaire study indicated that in assessing the urgent need for support, a significant positive association prevailed in the resident cohort with female gender, age over 50 years or being a parent. Professionals and politicians estimated that appropriate care and access to care would be obtained in the maternity and child health clinic in the local health centre. Residents would contact relatives rather than social and health care professionals. A future challenge is to promote the knowledge and sensitivity of the general population in recognizing mental symptoms in mothers with small children. Adequate information is also called for regarding local services and means of access to care.     

Respiratory and skin health among glass microfiber production workers: a cross-sectional study

Background  

Only a few studies have investigated non-malignant respiratory effects of glass microfibers and these have provided inconsistent results. Our objective was to assess the effects of exposure to glass microfibers on respiratory and skin symptoms, asthma and lung function.     

An analysis of ophthalmology services in Finland - has the time come for a Public-Private Partnership?

Background  

We studied the prerequisites for Public-Private Partnership (PPP) in the context of the Finnish health care system and more specifically in the field of ophthalmology. PPP can be defined as a more or less permanent cooperation between public and private actors, through which the joint products or services are developed and in which the risks, costs and profits are shared.     

Vestibular disorders following head injury in children

One hundred and ninety-nine child patients with blunt head injury were examined. Spontaneous and/or positional nystagmus (greater than or equal to 7 degrees/s) was observed immediately after trauma in 46% of cases, 6-12 months (average 10.2 months) later in 20%, and 2-8 years (average 4.7 years) later in 18%. Central ENG disturbances were found immediately after trauma in 43% of cases, 6-12 months later in 24%, and 2-8 years later in 12%. Only 1.5% of the child patients suffered from vertigo more than 6 months after trauma. The results of the study led to the conclusion that head injuries cause about as many similar objective vestibular lesions in children as in adults but fewer subjective symptoms.     

Identification of PKCalpha isoform-specific effects in cardiac myocytes using antisense phosphorothioate oligonucleotides

Members of the mammalian protein kinase C (PKC) superfamily play key regulatory roles in multiple cellular processes. In the heart, PKC signaling is involved in hypertrophic agonist-induced gene expression and hypertrophic growth. To investigate the specific function of PKC signaling in regulating cardiomyocyte growth, we used antisense oligonucleotides to inhibit PKC alpha, the major isozyme present in the neonatal heart. Transfection of cultured neonatal cardiomyocytes with antisense PKCalpha oligonucleotides resulted in a marked reduction in both PKCalpha mRNA and protein levels. PKCalpha antisense treatment also reduced phenylephrine (PE)-induced PKC activity and perinuclear translocation of PKCalpha. Antisense inhibition of PKCalpha led to reduction of PE-induced increase in skeletal alpha-actin mRNA levels and atrial natriuretic peptide (ANP) secretion but had no significant effects on PE-induced beta-myosin heavy chain, ANP, or B-type natriuretic peptide (BNP) gene expression. On the other hand, antisense PKCalpha treatment attenuated endothelin-1-induced increase in ANP and BNP peptide secretion, whereas endothelin-1-induced gene expression of ANP and BNP remained unchanged. The hypertrophic agonist-induced growth of cardiomyocytes, characterized by increased [(3)H]leucine incorporation, was not affected with antisense PKCalpha treatment. Furthermore, we found that PE-induced increase in extracellular signal-regulated kinase (ERK) activity was partially inhibited by antisense PKCalpha treatment, implicating ERK as a downstream mediator for PKCalpha signaling. These results indicate that PKCalpha isozyme is involved in hypertrophic signaling in cardiomyocytes and provide novel strategies for future studies to identify other cellular targets controlled selectively by PKCalpha or other PKC isozymes.     

Influence of enriched environment on spatial learning following cerebral insult

The fact that our brain is continuously shaped by the environment and experience presents many challenges. It was noted several decades ago that exposure of a laboratory rat to a complex environment alters its brain and improves problem solving in complex tasks. Rats that are housed in an enriched environment can better compensate for brain lesion-induced deficits and resist neurodegeneration. In this article, the role of an enriched environment on brain plasticity following experimentally-induced lesions is discussed.