Con: Methylprednisolone is not indicated for patients during cardiopulmonary bypass

Impact of Early Postoperative Hydrocortisone Administration in Cardiac Surgical Patients after Cardiopulmonary Bypass

BACKGROUND:

The usefulness of glucocorticoids after cardiac surgery with cardiopulmonary bypass has been a matter of debate for many years. Exposure to cardiopulmonary bypass evokes the systemic inflammatory response syndrome in patients undergoing cardiac surgery. Intravenous glucocorticoids have been used to reduce proinflammatory cytokine release, slow leukocyte migration, and decrease capillary leak associated with cardiopulmonary bypass.

OBJECTIVE:

To assess the impact of early postoperative hydrocortisone administration on duration of vasoactive medication administration and the incidence of postoperative atrial fibrillation in cardiac surgical patients after cardiopulmonary bypass.

METHODS:

A retrospective cohort study (between July 1, 2004, and June 30, 2008) was conducted at a large, university-affiliated, tertiary-care medical center. One-hundred forty-seven patients who underwent cardiac surgery with cardiopulmonary bypass, 72 of whom received at least 1 dose of hydrocortisone (treatment), and 75 similar patients who did not receive hydrocortisone (control), were randomly selected.

RESULTS:

Cardiopulmonary bypass and aortic cross-clamp times were similar between treatment and control groups (128 vs 124 minutes, p = 0.56; 103 vs 98 minutes, p = 0.39). Patients who received hydrocortisone had a significantly shorter time to discontinuation of all vasoactive medications (79.6 vs 21.1 hours, p < 0.001), and less postoperative atrial fibrillation (OR 0.28, 95% CI 0.14 to 0.56, p < 0.001). Patients in the treatment group experienced significantly more hyperglycemia (89 vs 71%, p = 0.006); however, major and minor bleeding or infection rates did not differ significantly between groups.

CONCLUSIONS:

Patients treated with hydrocortisone after cardiac surgery with cardiopulmonary bypass experienced a significantly shorter time to discontinuation of all vasoactive medications and less postoperative atrial fibrillation than patients not treated with hydrocortisone. These benefits came at the expense of significantly more hyperglycemia.

Gender differences in socio-demographic and clinical characteristics of methamphetamine inpatients in a Chinese population

BACKGROUND

Over the past two decades, China has experienced a dramatic increase in methamphetamine (MA) abuse. This study examined gender-specific socio-demographic and clinical characteristics of MA use among Han Chinese, which has previously received little systematic study.

METHODS

This analysis described MA-related socio-demographic and clinical characteristics in a broad cross-sectional sample (n=1464; male/female=1185/279), and examined differences between males and females in MA use history, MA initiation, MA-related subjective feelings and behaviors, and withdrawal symptoms.

RESULTS

Most MA abusers (about 72%) were young (in their 20s or 30s), with women being 5 years younger than men on average. More males (33.2%) were married than females (21.9%). The average body mass index (BMI) was significantly lower in this MA abuser sample compared to the age-matched healthy controls. Moreover, the BMI of females was significantly lower than that of males. The laboratory tests showed that the blood levels of glucose, cholesterol and triglyceride were all significantly higher in males than females. Females used MA at a younger age compared to males. The most frequent route of MA use was smoking (90.9%). Males were more likely to use another drug, and more likely to be hospitalized. However, many characteristics and behaviors of MA use are similar for males and females, including the route, the dose and duration of MA use, and relapse status.

CONCLUSION

Although there were some male-female similarities in MA use parameters, significant differences do exist that may have implications for gender-specific research as well as for prevention and treatment strategies.

The use of TP10, soluble complement receptor 1, in cardiopulmonary bypass

Cardiopulmonary bypass (CPB) for cardiac surgery or lung transplantation initiates a systemic inflammatory response characterized by increased vascular permeability, generalized edema, abnormal lung function and oxygenation and impaired ventricular function. This post-CPB syndrome significantly contributes to postoperative morbidity and mortality. Activation of complement during CPB is a key component that initiates and augments this process. TP10, soluble complement receptor 1, is a novel complement inhibitor that is a potent inhibitor of C3 and C5 convertases, blocking activation of the complement cascade at the nexus of all three complement pathways. Recent controlled trials in humans have demonstrated that TP10 effectively inhibits complement activation during CPB. In high-risk adult patients, TP10 decreases the incidence of mortality and myocardial infarction in males but not in females following cardiac surgery. TP10 is also well tolerated and protects vascular function in infants undergoing CPB. In addition, TP10 leads to early extubation in adult lung transplant recipients. TP10 is currently positioned for clinical development in a male-only indication of cardiac surgery on CPB.