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Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy 总被引:1,自引:0,他引:1
Aoife M. Ryan Aine Hearty Ruth S. Prichard Aileen Cunningham Suzanne P. Rowley John V. Reynolds 《Journal of gastrointestinal surgery》2007,11(10):1355-1360
Objective Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma
and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute
albumin level on the first postoperative day was of value in predicting in-hospital complications.
Methods A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and
2005 was performed. Patients who had pre and postoperative (days 1, 3, and 7) serum albumin levels measured were included
in the study. Patients were subdivided into three postoperative albumin categories <20 g/l, 20–25 g/l, >25 g/l. Logistic regression
analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level.
Results Patients with an albumin of less than 20 g/l on the first postoperative day were twice as likely to develop postoperative
complications than those with an albumin of greater than 20 g/l (54 vs 28% respectively, p < 0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome (22
vs 5%, p < 0.001), respiratory failure (27 vs 8%, p < 0.01) and in-hospital mortality (27 vs 6% (p < 0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications
(odds ratios, 0.89: 95%; confidence intervals, 0.83–0.96; p < 0.005). In addition, albumin <20 g/l on the first postoperative day was associated with the need for further surgery and
a return to ICU.
Conclusion Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative
risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes. 相似文献
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Distribution of mutations in the PEX gene in families with X-linked hypophosphataemic rickets (HYP) 总被引:8,自引:0,他引:8
Rowe PS; Oudet CL; Francis F; Sinding C; Pannetier S; Econs MJ; Strom TM; Meitinger T; Garabedian M; David A; Macher MA; Questiaux E; Popowska E; Pronicka E; Read AP; Mokrzycki A; Glorieux FH; Drezner MK; Hanauer A; Lehrach H; Goulding JN; O'Riordan JL 《Human molecular genetics》1997,6(4):539-549
Mutations in the PEX gene at Xp22.1 (phosphate-regulating gene with
homologies to endopeptidases, on the X-chromosome), are responsible for
X-linked hypophosphataemic rickets (HYP). Homology of PEX to the M13 family
of Zn2+ metallopeptidases which include neprilysin (NEP) as prototype, has
raised important questions regarding PEX function at the molecular level.
The aim of this study was to analyse 99 HYP families for PEX gene
mutations, and to correlate predicted changes in the protein structure with
Zn2+ metallopeptidase gene function. Primers flanking 22 characterised
exons were used to amplify DNA by PCR, and SSCP was then used to screen for
mutations. Deletions, insertions, nonsense mutations, stop codons and
splice mutations occurred in 83% of families screened for in all 22 exons,
and 51% of a separate set of families screened in 17 PEX gene exons.
Missense mutations in four regions of the gene were informative regarding
function, with one mutation in the Zn2+-binding site predicted to alter
substrate enzyme interaction and catalysis. Computer analysis of the
remaining mutations predicted changes in secondary structure,
N-glycosylation, protein phosphorylation and catalytic site molecular
structure. The wide range of mutations that align with regions required for
protease activity in NEP suggests that PEX also functions as a protease,
and may act by processing factor(s) involved in bone mineral metabolism.
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