SAPS 3 is not superior to SAPS 2 in cardiac surgery patients

Objectives. Cardiac surgery patients are excluded from SAPS2 but included in SAPS3. Neither score is evaluated for this exclusive population; however, they are used daily. We hypothesized that SAPS3 may be superior to SAPS2 in outcome prediction in cardiac surgery patients. Design. All consecutive patients undergoing cardiac surgery between January 2007 and December 2010 were included in our prospective study. Both models were tested with calibration and discrimination statistics. We compared the AUC of the ROC curves by DeLong's method and calculated OCC values. Results. A total of 5207 patients with mean age of 67.2 ± 10.9 years were admitted to the ICU. The mean length of ICU stay was 4.6 ± 7.0 days and the ICU mortality was 5.9%. The two tested models had acceptable discriminatory power (AUC: SAPS2: 0.777–0.875; SAPS3: 0.757–893). SAPS3 had a low AUC and poor calibration on admission day. SAPS2 had poor calibration on Days 1–6 and 8. Conclusions. Despite including cardiac surgery patients, SAPS3 was not superior to SAPS2 in our analysis. In this large cohort of ICU cardiac surgery patients, performance of both SAPS models was generally poor. In this subset of patients, neither scoring system is recommended.     

Biological effects of gum arabic: A review of some recent research

Gum arabic (GA) is a branched-chain, complex polysaccharide, either neutral or slightly acidic, found as a mixed calcium, magnesium and potassium salt of a polysaccharidic acid. The backbone is composed of 1,3-linked β-d-galactopyranosyl units. The side chains are composed of two to five 1,3-linked β-d-galactopyranosyl units, joined to the main chain by 1,6-linkages. Pharmacologically, GA has been claimed to act as an anti-oxidant, and to protect against experimental hepatic-, renal- and cardiac toxicities in rats. These reports could not be confirmed by others. GA has been claimed to alleviate the adverse effects of chronic renal failure in humans. This could not be corroborated experimentally in rats. Reports on the effects of GA on lipid metabolism in humans and rats are at variance, but mostly suggest that GA ingestion can reduce plasma cholesterol concentrations in rats. GA has proabsorptive properties and can be used in diarrhoea. It enhances dental remineralization, and has some antimicrobial activity, suggesting a possible use in dentistry. GA has been shown to have an adverse effect on electrolyte balance and vitamin D in mice, and to cause hypersensitivity in humans. More studies are needed before the pharmacological properties of GA can be utilized in therapy.     

A comparative study of four intensive care outcome prediction models in cardiac surgery patients

Background  

Outcome prediction scoring systems are increasingly used in intensive care medicine, but most were not developed for use in cardiac surgery patients. We compared the performance of four intensive care outcome prediction scoring systems (Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology Score II [SAPS II], Sequential Organ Failure Assessment [SOFA], and Cardiac Surgery Score [CASUS]) in patients after open heart surgery.     

Exacerbation of thrombotic events by diesel exhaust particle in mouse model of hypertension

Several epidemiological studies have shown that acute exposure to particulate air pollution is associated with increases in cardiovascular morbidity and mortality, and that these effects are especially exacerbated among individuals with pre-existing compromised cardiovascular function such as hypertension. This study was undertaken to determine the cardiovascular effect of diesel exhaust on TO mice made hypertensive by implanting osmotic minipump infusing angiotensin II or vehicle (control). On day 13, the animals were intratracheally instilled with either DEP (15 μg/mouse) or saline. 24 h later, pulmonary exposure to DEP had significantly decreased the systolic blood pressure (SBP) in hypertensive (HT) mice (P<0.01), but not in normotensive (NT) mice. The number of leukocytes and red blood cells, and the plasma interleukin 6 concentration in plasma, however, were not affected in any of the animals. The PaO? was decreased, and PaCO? increased in DEP-treated HT mice compared to NT mice treated with DEP (P<0.05). The number of circulating platelets was significantly increased in DEP-treated HT versus saline-treated HT and DEP-treated NT mice. Moreover, in NT mice, DEP exposure induced a prothrombotic effect in pial arterioles compared with saline-treated NT mice (P<0.05). Interestingly, in DEP-treated HT mice, the prothrombotic events were significantly aggravated compared with saline-treated HT and DEP-treated NT mice. The direct addition of DEP (0.1-1 μg/ml) to untreated mouse blood significantly induced in vitro platelet aggregation in a dose-dependent fashion, and these effects were more pronounced in blood of HT mice. In vitro exposure to DEP (0.25-1 μg/ml) led to activated intravascular coagulation, an effect that was confirmed by a shortening of both the activated partial thromboplastin time (aPTT) and the prothrombin time (PT). The effect of DEP on aPTT was potentiated in the plasma of HT mice. It can be concluded that the thrombotic events caused by DEP are exacerbated by hypertension in mice. Our findings, therefore, provide a possible plausible explanation for the cardiovascular morbidity and mortality accompanying urban air pollution.     

Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus

BACKGROUND: Barrett's surveillance is prone to sampling error. Aim To determine whether enhanced magnification endoscopy using acetic acid instillation improves diagnostic accuracy of specialized intestinal metaplasia/dysplasia in Barrett's oesophagus. METHODS: We examined the detection rate of the specialized intestinal metaplasia/dysplasia in 64 consecutive patients with Barrett's oesophagus using acetic acid to enhance mucosal pit patterns. Histology was compared with the previous findings at recent conventional surveillance in 62 patients. We also examined the inter-/intra-observer agreement in the assessment of the enhanced magnification endoscopy pit pattern findings. RESULTS: Histology revealed columnar-lined oesophagus in six (9%) patients, specialized intestinal metaplasia in 49 (77%), low-grade dysplasia in five (8%), high-grade dysplasia in one (2%), and adenocarcinoma in three (5%). There was discordance between the histologic findings from conventional surveillance with random biopsy. Fifteen patients (24%) had a histological upgrade with enhanced magnification endoscopy. There was a high detection rate of specialized intestinal metaplasia even in short segment Barrett's oesophagus (74%), and additionally, there were two cancers, one with 2-cm Barrett's oesophagus and one ultra-short (1 cm). The mean kappa values for inter- and intra-observer agreement in assessing the pit patterns were 0.571 (0.041) and 0.709 (0.038), respectively. CONCLUSIONS: Enhanced magnification endoscopy allows clear visualization of the epithelial pit patterns within Barrett's oesophagus, and targeted biopsy results in a high yield of specialized intestinal metaplasia and dysplasia.     

Hormonal replacement therapy in an animal model with chronic renal failure and gonadectomy: biochemical and hematological study

The aim of the present study was to investigate the effects of subcutaneous administration of estradiol propionate (450 microg/kg female rat/day) or testosterone propionate (2 mg/kg male rat/day) for 4 weeks on some biochemical and hematological variables in intact and gonadectomized male and female rats with chronic renal failure (CRF) induced by 7/8 nephrectomy (remnant kidney model). Twenty-four hours after the last injection, rats were decapitated and blood samples were collected for complete hemogram and for measuring the concentrations of creatinine, urea, and indoxyl sulphate in plasma. Body weights of all rats were taken every week during the experimental period. The hematological and biochemical parameters measured in the sham-operated and gonadectomized rats were not significantly different from those in intact rats. Induction of CRF significantly increased the concentrations of creatinine, urea, and indoxyl sulphate by about 90-300% (P < 0.05), and caused signs indicative of anemia. These effects were significantly exacerbated in gonadectomized rats with CRF, and were partially and significantly reversed by exogenous administration of testosterone/estradiol. The changes induced by CRF and gonadectomy on the hematocrit (HTC) and hemoglobin concentration (HGB) were more pronounced in females than in males. The HTC and HGB in gonadectomized male rats with CRF were not significantly different from the controls. In the rest of the groups, there were no significant gender effects in the measured variables. It is suggested that, in the used rat model of CRF, there is depressed growth; significant increases in the plasma concentrations of creatinine, urea, and indoxyl sulphate; and anemia. All these signs were significantly and partially reversed by estradiol and testosterone therapy equally in female and male rats, respectively.     

N‐acetylcysteine improves renal hemodynamics in rats with cisplatin‐induced nephrotoxicity

This work investigated the effect of N‐acetylcysteine (NAC), on renal hemodynamics in cisplatin (CP)‐induced nephrotoxicity in Wistar–Kyoto (WKY) rats. The animals were divided into four groups (n = 5 or 6). The first and second groups received normal saline (control) and intraperitoneal (i.p.) N‐acetylcysteine (500 mg kg^?1 per day for 9 days), respectively. The third and fourth groups were given a single intraperitoneal (i.p.) injection of CP (5 mg kg^?1) and an i.p. injection of CP (5 mg kg^?1) together with i.p. NAC (500 mg kg^?1 per day for 9 days), respectively. At the end of the experiment, rats were anesthetized and blood pressure and renal blood flow were monitored, followed by intravenous (i.v.) injection of norepinephrine (NE) for measurement of renal vasoconstrictor responses. CP caused a significant reduction in renal blood flow but did not affect NE‐induced renal vasoconstriction. In addition, CP significantly increased plasma concentrations of urea and creatinine and urinary N‐acetyl‐β‐D ‐glucosaminidase (NAG) activity and kidney relative weight. CP decreased body weight and creatinine clearance. Histopathologically, CP caused remarkable renal damage compared with control. NAC alone did not produce any significant change in any of the variables measured. However, NAC significantly ameliorated CP‐induced hemodynamic, biochemical and histopathological changes. The concentration of platinum in the kidneys of CP ? NAC treated rats was less than in CP‐treated rats by 37%. The results show that administration of i.p. NAC (500 mg kg^?1 per day for 9 days) reversed the renal hemodynamic changes as well as the biochemical and histopathological indices of CP‐induced nephrotoxicity in WKY rats. Copyright © 2009 John Wiley & Sons, Ltd.