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Ferreira LO, Vasconcelos VW, Lima JDS, Vieira Neto JR, da Costa GE, Esteves JDC, de Sousa SC, Moura JA, Santos FRS, Leitão Filho JM, Protásio MR, Araújo PS, Lemos CJDS, Resende KD, Lopes DCF. Biochemical Changes in Cardiopulmonary Bypass in Cardiac Surgery: New Insights. J Pers Med 2023; 13:1506. [PMID: 37888117 PMCID: PMC10608001 DOI: 10.3390/jpm13101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 10/28/2023] Open
Abstract
Patients undergoing coronary revascularization with extracorporeal circulation or cardiopulmonary bypass (CPB) may develop several biochemical changes in the microcirculation that lead to a systemic inflammatory response. Surgical incision, post-CPB reperfusion injury and blood contact with non-endothelial membranes can activate inflammatory signaling pathways that lead to the production and activation of inflammatory cells, with cytokine production and oxidative stress. This inflammatory storm can cause damage to vital organs, especially the heart, and thus lead to complications in the postoperative period. In addition to the organic pathophysiology during and after the period of exposure to extracorporeal circulation, this review addresses new perspectives for intraoperative treatment and management that may lead to a reduction in this inflammatory storm and thereby improve the prognosis and possibly reduce the mortality of these patients.
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Affiliation(s)
- Luan Oliveira Ferreira
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil
| | - Victoria Winkler Vasconcelos
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Janielle de Sousa Lima
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Jaime Rodrigues Vieira Neto
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Giovana Escribano da Costa
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Jordana de Castro Esteves
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Sallatiel Cabral de Sousa
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Jonathan Almeida Moura
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Felipe Ruda Silva Santos
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - João Monteiro Leitão Filho
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | | | - Pollyana Sousa Araújo
- Department of Cardiovascular Anesthesiology, Hospital Clínicas Gaspar Vianna, Belém 66083-106, Brazil; (P.S.A.); (C.J.d.S.L.)
| | - Cláudio José da Silva Lemos
- Department of Cardiovascular Anesthesiology, Hospital Clínicas Gaspar Vianna, Belém 66083-106, Brazil; (P.S.A.); (C.J.d.S.L.)
| | - Karina Dias Resende
- Residency Program in Anesthesiology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil; (V.W.V.); (J.d.S.L.); (J.R.V.N.); (G.E.d.C.); (J.d.C.E.); (S.C.d.S.); (J.A.M.); (F.R.S.S.); (J.M.L.F.); (K.D.R.)
| | - Dielly Catrina Favacho Lopes
- Laboratory of Experimental Neuropathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém 66073-000, Brazil
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Huang H, Han J, Li Y, Yang Y, Shen J, Fu Q, Chen Y. Early Serum Metabolism Profile of Post-operative Delirium in Elderly Patients Following Cardiac Surgery With Cardiopulmonary Bypass. Front Aging Neurosci 2022; 14:857902. [PMID: 35754961 PMCID: PMC9226449 DOI: 10.3389/fnagi.2022.857902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac surgery with cardiopulmonary bypass (CPB) is considered to be one of the surgical types with the highest incidence of post-operative delirium (POD). POD has been associated with a prolonged intensive care and hospital stay, long-term neurocognitive deterioration, and increased mortality. However, the specific pathogenesis of POD is still unclear. Untargeted metabolomics techniques can be used to understand the changes of serum metabolites in early POD to discover the relationship between serum metabolites and disease. Materials and Methods The present study recruited 58 elderly patients undergoing cardiac surgery with CPB. Serum was collected within the first 24 h after surgery. The Confusion Assessment Method (CAM) and ICU-CAM assessments were used to identify patients who experienced POD. All patients with normal post-operative cognitive assessment were included in the non-POD groups. Moreover, we collected serum from 20 healthy adult volunteers. We performed untargeted analyses of post-operative serum metabolites in all surgical groups, as well as serum metabolites in healthy non-surgical adults by using liquid chromatography mass spectrometry (LC/MS) and analyzed metabolic profiles and related metabolites. Results The probability of POD after cardiac surgery were 31%. There were statistically significant differences in post-operative mechanical ventilation time, ICU stay time and post-operative hospital stay between POD and non-POD group (P < 0.05). And ICU stay time was an independent risk factor for POD. The analysis revealed that a total of 51 differentially expressed metabolites (DEMs) were identified by comparing the POD and non-POD group, mostly lipids and lipid-like molecules. Three phosphatidylinositol (PI) were down-regulated in POD group, i.e., PI [18:0/18:2 (9Z, 12Z)], PI [20:4 (8Z, 11Z, 14Z, 17Z)/18:0], and PI [18:1 (9Z)/20:3 (8Z, 11Z, 14Z)]. The receiver operating characteristic (ROC) curve analysis showed that three kinds of PI metabolites had the highest area under the curve (AUC), which were 0.789, 0.781, and 0.715, respectively. Correlation analysis showed that the expression of three PIs was negatively correlated with the incidence of POD. Conclusion Our findings suggest that lipid metabolism plays an important role in the serum metabolic profile of elderly patients with POD in the early post-operative period. Low serum lipid metabolic PI was associated with incidence of POD in elderly following cardiac bypass surgery, which may provide new insights into the pathogenesis of POD.
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Affiliation(s)
- He Huang
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jingjing Han
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Li
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yonglin Yang
- Division of Infectious Diseases, Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou, China
| | - Jian Shen
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Fu
- Nanjing Red Cross Blood Center, Nanjing, China
| | - Yu Chen
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Brioschi M, Gianazza E, Andreini D, Mushtaq S, Cavallotti L, Veglia F, Tedesco CC, Colombo GI, Pepi M, Polvani G, Tremoli E, Parolari A, Banfi C. Mercaptoalbumin Is Associated with Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting. Antioxidants (Basel) 2022; 11:antiox11040702. [PMID: 35453387 PMCID: PMC9029960 DOI: 10.3390/antiox11040702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 12/07/2022] Open
Abstract
Coronary artery bypass graft (CABG) surgery still represents the gold standard for patients with complex multivessel coronary artery disease. However, graft occlusion still occurs in a significant proportion of CABG conduits, and oxidative stress is currently considered to be a potential contributor. Human serum albumin (HSA) represents the main antioxidant in plasma through its reduced amino acid Cys34, which can efficiently scavenge several oxidants. In a nested case–control study including 36 patients with occluded grafts and 38 age- and sex-matched patients without occlusion, we assessed the levels of the native mercaptoalbumin (HSA-SH) and oxidized thiolated form of albumin (Thio-HSA) in relation with graft occlusion within 5 years after CABG. We found that the plasma level of preoperative HSA-SH was significantly lower in patients with occluded graft at 5 years follow-up than in patients with graft patency. Furthermore, low HSA-SH remained independently associated with graft occlusion even after adjusting for preoperative D-dimer, a well-known marker of activated coagulation recently found to be associated with graft occlusion. In conclusion, the preoperative level of HSA-SH is independently associated with graft occlusion in CABG and represents a measurable and potentially druggable predictor.
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Affiliation(s)
- Maura Brioschi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Erica Gianazza
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20157 Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Laura Cavallotti
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Fabrizio Veglia
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Calogero C. Tedesco
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Gualtiero I. Colombo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Gianluca Polvani
- Cardiovascular Tissue Bank of Milan, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy;
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
- Development and Innovation Cardiac Surgery Unit, Department of Cardiovascular Disease, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Elena Tremoli
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
| | - Alessandro Parolari
- Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, S.Donato Milanese, 20097 Milan, Italy;
| | - Cristina Banfi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.B.); (E.G.); (D.A.); (S.M.); (L.C.); (F.V.); (C.C.T.); (G.I.C.); (M.P.); (E.T.)
- Correspondence: or ; Tel.: +39-0258002403; Fax: +39-0258002623
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Zheng XM, Yang Z, Yang GL, Huang Y, Peng JR, Wu MJ. Lung injury after cardiopulmonary bypass: Alternative treatment prospects. World J Clin Cases 2022; 10:753-761. [PMID: 35127892 PMCID: PMC8790450 DOI: 10.12998/wjcc.v10.i3.753] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/29/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Although the lung injury caused by cardiopulmonary bypass (CPB) has been extensively investigated, the incidence and mortality of lung injury after CPB remain a prominent clinical problem. The poor outcome has been attributed to multifactorial etiology, including the systemic inflammatory response and ischemia reperfusion (I/R) injury during CPB. Lung injury after CPB is a complex pathophysiological process and has many clinical manifestations of mild to severe disease. Which is associated with prognosis. To alleviate this lung injury, interventions that address the pathogenesis are particularly important. This review summarizes the pathogenesis, mechanism and treatment options of lung injury after CPB, such as lung protection with intralipid.
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Affiliation(s)
- Xue-Mei Zheng
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Zhuo Yang
- Department of Pharmacy, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Guang-Li Yang
- Department of Medical Administration, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Yan Huang
- National Institute of Drug Clinical Trial, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Jie-Ru Peng
- Department of Medical Records Statistics, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
| | - Meng-Jun Wu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu 610000, Sichuan Province, China
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Travica N, Ried K, Hudson I, Scholey A, Pipingas A, Sali A. The effects of cardiovascular and orthopaedic surgery on vitamin concentrations: a narrative review of the literature and mechanisms of action. Crit Rev Food Sci Nutr 2021:1-31. [PMID: 34619992 DOI: 10.1080/10408398.2021.1983762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the rise in worldwide chronic diseases, supplemented by an aging population, the volume of global major surgeries, encompassing cardiac and orthopedic procedures is anticipated to surge significantly. Surgical trauma can be accompanied by numerous postoperative complications and metabolic changes. The present review summarized the results from studies assessing the effects of orthopedic and cardiovascular surgery on vitamin concentrations, in addition to exploring the possible mechanisms associated with changes in concentrations. Studies have revealed a potentially severe depletion in plasma/serum concentrations of numerous vitamins following these surgeries acutely. Vitamins C, D and B1 appear particularly vulnerable to significant depletions, with vitamin C and D depletions consistently transpiring into inadequate and deficient concentrations, respectively. The possible multifactorial mechanisms impacting postoperative vitamin concentrations include changes in hemodilution and vitamin utilization, redistribution, circulatory transport and absorption. For a majority of vitamins, there has been a lack of investigation into the effects of both, cardiac and orthopedic surgery. Additionally, studies were predominantly restricted to short-term postoperative investigations, primarily performed within the first postoperative week of surgery. Overall, results indicated that further examination is necessary to determine the severity and clinical significance of the possible depletions in vitamin concentrations that ensue cardiovascular and orthopedic surgery.
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Affiliation(s)
- Nikolaj Travica
- Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, the Institute for Mental and Physical Health and Clinical Translation (IMPACT), Geelong, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,The National Institute of Integrative Medicine, Melbourne, Australia
| | - Karin Ried
- The National Institute of Integrative Medicine, Melbourne, Australia.,Honorary Associate Professor, Discipline of General Practice, University of Adelaide, South Australia, Australia.,Torrens University, Melbourne, Australia
| | - Irene Hudson
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia.,Digital Health, CRC, College of STEM, Mathematical Sciences, Royal Melbourne Institute of Technology (RMIT), Melbourne, Australia.,School of Mathematical and Physical Science, University of Newcastle, Newcastle, Australia
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Avni Sali
- The National Institute of Integrative Medicine, Melbourne, Australia
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Clendenen N, Abrams B, Morabito J, Grae L, Mosca MS, Weitzel N. Noteworthy Literature in Cardiac Anesthesia for 2019. Semin Cardiothorac Vasc Anesth 2020; 24:138-148. [DOI: 10.1177/1089253220921588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article represents a selective review of literature published in 2019. Initial results from PubMed searching for a combination of terms, including cardiac anesthesiology and anesthesiology outcomes, yielded more than 1400 publications. From there, we manually screened the results and identified 5 major themes for the year of 2019, including transcatheter techniques, delirium and anesthesiology, coagulation management following cardiopulmonary bypass, perfusion management with del Nido cardioplegia, and applied clinical research. The following research accomplishments have expanded what is possible and set ambitious goals for the future.
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Affiliation(s)
| | | | | | - Lyndsey Grae
- University of Colorado School of Medicine, Aurora, CO, USA
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Raffaeli G, Ghirardello S, Passera S, Mosca F, Cavallaro G. Oxidative Stress and Neonatal Respiratory Extracorporeal Membrane Oxygenation. Front Physiol 2018; 9:1739. [PMID: 30564143 PMCID: PMC6288438 DOI: 10.3389/fphys.2018.01739] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022] Open
Abstract
Oxidative stress is a frequent condition in critically ill patients, especially if exposed to extracorporeal circulation, and it is associated with worse outcomes and increased mortality. The inflammation triggered by the contact of blood with a non-endogenous surface, the use of high volumes of packed red blood cells and platelets transfusion, the risk of hyperoxia and the impairment of antioxidation systems contribute to the increase of reactive oxygen species and the imbalance of the redox system. This is responsible for the increased production of superoxide anion, hydrogen peroxide, hydroxyl radicals, and peroxynitrite resulting in increased lipid peroxidation, protein oxidation, and DNA damage. The understanding of the pathophysiologic mechanisms leading to redox imbalance would pave the way for the future development of preventive approaches. This review provides an overview of the clinical impact of the oxidative stress during neonatal extracorporeal support and concludes with a brief perspective on the current antioxidant strategies, with the aim to focus on the potential oxidative stress-mediated cell damage that has been implicated in both short and long-term outcomes.
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Affiliation(s)
- Genny Raffaeli
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ghirardello
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sofia Passera
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Hadj Ahmed S, Kharroubi W, Kaoubaa N, Zarrouk A, Batbout F, Gamra H, Najjar MF, Lizard G, Hininger-Favier I, Hammami M. Correlation of trans fatty acids with the severity of coronary artery disease lesions. Lipids Health Dis 2018; 17:52. [PMID: 29544473 PMCID: PMC5856295 DOI: 10.1186/s12944-018-0699-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/07/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nutritional choices, which include the source of dietary fatty acids (FA), have an important significant impact on coronary artery disease (CAD). We aimed to determine on patients with CAD the relationships between Trans fatty acids (Trans FA) and different CAD associated parameters such as inflammatory and oxidative stress parameters in addition to Gensini score as a vascular severity index. METHODS Fatty acid profiles were established by gas chromatography from 111 CAD patients compared to 120 age-matched control group. Lipid peroxidation biomarkers, oxidative stress, inflammatory parameters and Gensini score were studied. RESULTS Our study showed a significant decrease of the antioxidant parameters levels such as erythrocyte glutathione peroxydase (GPx) and superoxide dismutase (SOD) activities, plasma antioxidant status (FRAP) and thiol (SH) groups in CAD patients. On the other hand, catalase activity, conjugated dienes and malondialdehyde were increased. Plasmatic and erythrocyte Trans FA were also increased in CAD patients compared to controls. Furthermore, divergent associations of these Trans FA accumulations were observed with low-density lipoprotein-cholesterol/ high-density lipoprotein-cholesterol (LDL-C/HDL-C) ratio, Apolipoprotein B (ApoB), lipid peroxidation parameters, high-sensitivity C Reactive Protein (hs-CRP), Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and Gensini score. Especially, elaidic acid (C18:1 trans 9), trans C18:2 isomers and trans 11 eicosanoic acid are correlated with these parameters. Trans FA are also associated with oxidative stress, confirmed by a positive correlation between C20:1 trans 11 and GPx in erythrocytes. CONCLUSIONS High level of Trans FA was highly associated with the induction of inflammation, oxidative stress and lipoperoxidation which appear to be based on the vascular severity and might be of interest to assess the stage and progression of atherosclerosis. The measurement of these Trans FA would be of great value for the screening of lipid metabolism disorders in CAD patients.
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Affiliation(s)
- Samia Hadj Ahmed
- Research Laboratory LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health' Faculty of Medicine, University of Monastir, Avicene st, 5019, Monastir, Tunisia.
| | - Wafa Kharroubi
- Research Laboratory LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health' Faculty of Medicine, University of Monastir, Avicene st, 5019, Monastir, Tunisia
| | - Nadia Kaoubaa
- Research Laboratory LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health' Faculty of Medicine, University of Monastir, Avicene st, 5019, Monastir, Tunisia
| | - Amira Zarrouk
- Research Laboratory LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health' Faculty of Medicine, University of Monastir, Avicene st, 5019, Monastir, Tunisia
| | - Fathi Batbout
- Department of Cardiology, CHU Fattouma Bourguiba, Monastir, Tunisia
| | - Habib Gamra
- Department of Cardiology, CHU Fattouma Bourguiba, Monastir, Tunisia
| | | | - Gérard Lizard
- Team 'Biochemistry of the Peroxisome, Inflammation and Lipid Metabolism' EA 7270 / INSERM, University of Bourgogne Franche-Comté, Dijon, France
| | - Isabelle Hininger-Favier
- Laboratory of Fundamental and Applied Bioenergetic, INSERM, Grenoble Alpes University, F-38041, Grenoble, France
| | - Mohamed Hammami
- Research Laboratory LR12ES05 LR-NAFS 'Nutrition - Functional Food & Vascular Health' Faculty of Medicine, University of Monastir, Avicene st, 5019, Monastir, Tunisia
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Gil-Gómez R, Blasco-Alonso J, Sánchez-Yáñez P, Rosa-Camacho V, Milano Manso G. [Neopterin levels and systemic inflammatory response syndrome in pediatric critically ill patients]. An Pediatr (Barc) 2017; 87:343-349. [PMID: 28442215 DOI: 10.1016/j.anpedi.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/23/2016] [Accepted: 11/26/2016] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Neopterin and biopterin are sub-products of redox reactions, which act as cofactors of enzymes responsible for nitric oxide production. The hypothesis is presented that plasma neopterin and biopterin evolve differently during the first days in a critically ill child. METHODS A single-centre prospective observational study was conducted on patients 7 days to 14 years admitted to our Paediatric Intensive Care Unit (PICU) and that met Systemic inflammatory response syndrome (SIRS) criteria. Neopterin and biopterin levels, as well as other acute phase reactants, were collected at admission and at 24 h. RESULTS A total of 28 patients were included, of which 78.9% were male, The median age was 5.04 years (interquartile range [IQR] 1.47-10.26), and PRISM II 2.0% (IQR 1.1-5.0). Mechanical ventilation (MV) was used in 90% of patients, with a median duration of 6.0 hrs (IQR 3.7-102.0). The median length of stay in PICU was 5.0 days (IQR 2.7-18.7), maximum VIS mean of 0 (IQR 0-14). Baseline neopterin level was 2.3±1.2 nmol/l and at 24 h it was 2.3±1.4 nmol/l. Baseline biopterin was 1.3±0.5 nmol/l and 1.4±0.4 nmol/l at 24 h. Neopterin levels were significantly higher in patients with PICU length of stay > 6 days (P=.02), patients who needed MV >24 h (P=.023), and those who developed complications (P=.05). Neopterin correlates directly and is statistically significant with the duration of MV (rho=.6, P=.011), PICU length of stay (rho=.75, P<.0001), and VIS (rho=.73, P=.001). Additionally, biopterin directly correlates with the PRISM (rho=.61, P=.008). DISCUSSION There is a higher neopterin level when there is a longer PICU stay, higher VIS score, longer time on MV, and occurrence of complications, indicating the involvement of an activation of the cellular immune system.
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Affiliation(s)
- Raquel Gil-Gómez
- UGC de Cuidados Críticos y Urgencias Pediátricas, Hospital Regional Universitario de Málaga, Málaga, España
| | - Javier Blasco-Alonso
- Unidad de Gastroenterología, Hepatología y Nutrición Infantil, UGC de Pediatría, Hospital Regional Universitario de Málaga, Málaga, España; Grupo IBIMA Multidisciplinar Pediátrico de Investigación, Universidad de Málaga, Málaga, España.
| | - Pilar Sánchez-Yáñez
- UGC de Cuidados Críticos y Urgencias Pediátricas, Hospital Regional Universitario de Málaga, Málaga, España
| | - Vanessa Rosa-Camacho
- UGC de Cuidados Críticos y Urgencias Pediátricas, Hospital Regional Universitario de Málaga, Málaga, España
| | - Guillermo Milano Manso
- UGC de Cuidados Críticos y Urgencias Pediátricas, Hospital Regional Universitario de Málaga, Málaga, España; Grupo IBIMA Multidisciplinar Pediátrico de Investigación, Universidad de Málaga, Málaga, España
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Gil-Gómez R, Blasco-Alonso J, Sánchez-Yáñez P, Rosa-Camacho V, Milano G. Neopterin levels and systemic inflammatory response syndrome in pediatric critically ill patients. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Meng F, Ma J, Wang W, Lin B. Meta-analysis of interleukin 6, 8, and 10 between off-pump and on-pump coronary artery bypass groups. Bosn J Basic Med Sci 2017; 17:85-94. [PMID: 28284177 DOI: 10.17305/bjbms.2017.1505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/24/2022] Open
Abstract
This study aimed to evaluate the role of off-pump coronary artery bypass (CAB) surgery on the decrease of postoperative inflammatory responses in patients. We systematically searched databases of PubMed and Embase to select the related studies. Interleukin (IL) 6, 8, and 10 were used as outcomes and pooled analysis was performed using R 3.12 software. Standardized mean differences (SMDs) and their 95% confidence intervals (95% CIs) were considered as effect estimates. A total of 27 studies, including 1340 participants, were recruited in this meta-analysis. The pooled analyses showed that postoperative concentration of IL-10 at 12 hours was significantly lower in off-pump CAB group compared to on-pump CAB group (SMD = -1.3640, 95% CI = -2.0086--0.7193). However, no significant differences were found in pre and postoperative concentrations of IL-6 and 8 between off-pump and on-pump CAB groups. These results suggest that there is no advantage of off-pump CAB surgery in the reduction of inflammation compared to on-pump CAB surgery.
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Affiliation(s)
- Fanbo Meng
- Department of Cardiology, China Japan Union Hospital of Jilin University, Changchun, China.
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Plicner D, Stoliński J, Wąsowicz M, Gawęda B, Hymczak H, Kapelak B, Drwiła R, Undas A. Preoperative values of inflammatory markers predict clinical outcomes in patients after CABG, regardless of the use of cardiopulmonary bypass. Indian Heart J 2016; 68 Suppl 3:S10-S15. [PMID: 28038718 PMCID: PMC5198874 DOI: 10.1016/j.ihj.2016.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 09/25/2016] [Accepted: 10/18/2016] [Indexed: 12/12/2022] Open
Abstract
Objective The impact of systemic inflammation on clinical outcomes after CABG surgery is still controversial. In this study, we evaluated the impact of the markers of inflammation, endothelial damage and platelet activation on clinical outcomes after on- and off-pump CABG. Methods A group of 191 consecutive on- and off-pump CABG patients were prospectively studied. Blood samples were drawn before surgery, 18–36 h after the procedure and 5–7 days postoperatively and analyzed for 8-iso-prostaglandin F2α (8-iso-PGF2α), asymmetric dimethylarginine (ADMA) and β-thromboglobulin (β-TG). White blood count and C-reactive protein were measured twice, first before and then during the first 18–36 h after CABG. The primary clinical end-points were: low cardiac output syndrome (LCOS), postoperative myocardial infarction (PMI) and in-hospital cardiovascular death. Results Elevation of 8-iso-PGF2α, ADMA and β-TG before surgery was associated with an increased risk of morbidity and mortality after CABG. There were no differences in analyzed markers and clinical outcomes between the on- and off-pump groups. Even during the uncomplicated postoperative course the inflammatory response was enhanced and still remained higher than baseline 5–7 days after surgery. Conclusion Links between preoperative 8-iso-PGF2α, ADMA and β-TG and unfavorable early post-CABG outcomes suggest that these markers could be useful in identifying patients with increased risk of LCOS, PMI and in-hospital cardiovascular death following elective CABG.
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Affiliation(s)
- Dariusz Plicner
- Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland.
| | | | - Marcin Wąsowicz
- Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Bugusław Gawęda
- Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland
| | - Hubert Hymczak
- Department of Anesthesia, John Paul II Hospital, Krakow, Poland
| | - Bogusław Kapelak
- Department of Cardiosurgery, John Paul II Hospital, Krakow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Drwiła
- Department of Anesthesia, John Paul II Hospital, Krakow, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Stoliński J, Plicner D, Grudzień G, Wąsowicz M, Musiał R, Andres J, Kapelak B. A comparison of minimally invasive and standard aortic valve replacement. J Thorac Cardiovasc Surg 2016; 152:1030-9. [PMID: 27449562 DOI: 10.1016/j.jtcvs.2016.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/20/2016] [Accepted: 06/12/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The study objective was to compare aortic valve replacement through a right anterior minithoracotomy with aortic valve replacement through a median sternotomy. METHODS With propensity score matching, we selected 211 patients after aortic valve replacement through a right anterior minithoracotomy and 211 patients after aortic valve replacement who underwent operation between January 2010 and December 2013. Perioperative outcomes were analyzed, and multivariable logistic regression analysis of risk factors of postoperative morbidity was performed. RESULTS For propensity score-matched patients, hospital mortality was 1.0% in the aortic valve replacement through a right anterior minithoracotomy group and 1.4% in the aortic valve replacement group (P = 1.000). Stroke occurred in 0.5% versus 1.4% (P = .615), myocardial infarction occurred in 1.4% versus 1.9% (P = 1.000), and new onset of atrial fibrillation occurred in 12.8% versus 24.2% (P = .003) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Postoperative drainage was 353.5 ± 248.6 mL versus 544.3 ± 324.5 mL (P < .001) and blood transfusion was required for 48.8% versus 67.3% (P < .001) of patients in the aortic valve replacement through a right anterior minithoracotomy and aortic valve replacement groups, respectively. Mediastinitis occurred in 2.8% of patients after aortic valve replacement and in 0.0% of patients after aortic valve replacement through a right anterior minithoracotomy surgery (P = .040). Intensive care unit stay (1.3 ± 1.2 days vs 2.6 ± 2.6 days) and hospital stay (5.7 ± 1.6 days vs 8.7 ± 4.4 days) were statistically significantly shorter in the aortic valve replacement through a right anterior minithoracotomy group. Aortic valve replacement through a right anterior minithoracotomy surgery resulted in reduced postoperative morbidity (odds ratio, 0.4; P < .001) and postoperative bleeding and blood transfusion requirements (odds ratio, 0.4; P < .001). CONCLUSIONS Aortic valve replacement through a right anterior minithoracotomy surgery resulted in a reduced infection rate, diminished postoperative bleeding and blood transfusion requirements, reduced occurrence of new onset of atrial fibrillation, and shorter intensive care unit and hospital stays.
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Affiliation(s)
- Jarosław Stoliński
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland.
| | - Dariusz Plicner
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Grzegorz Grudzień
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Marcin Wąsowicz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Musiał
- Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Janusz Andres
- Department of Anesthesiology and Intensive Therapy, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University in Cracow, John Paul II Hospital, Cracow, Poland
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Oxidative Stress after Surgery on the Immature Heart. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:1971452. [PMID: 27123154 PMCID: PMC4830738 DOI: 10.1155/2016/1971452] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 01/14/2023]
Abstract
Paediatric heart surgery is associated with increased inflammation and the production of reactive oxygen species. Use of the extracorporeal cardiopulmonary bypass during correction of congenital heart defects generates reactive oxygen species by various mechanisms: haemolysis, neutrophil activation, ischaemia reperfusion injury, reoxygenation injury, or depletion of the endogenous antioxidants. The immature myocardium is more vulnerable to reactive oxygen species because of developmental differences compared to the adult heart but also because of associated congenital heart diseases that can deplete its antioxidant reserve. Oxidative stress can be manipulated by various interventions: exogenous antioxidants, use of steroids, cardioplegia, blood prime strategies, or miniaturisation of the cardiopulmonary bypass circuit. However, it is unclear if modulation of the redox pathways can alter clinical outcomes. Further studies powered to look at clinical outcomes are needed to define the role of oxidative stress in paediatric patients.
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Parolari A, Poggio P, Myasoedova V, Songia P, Pilozzi A, Alamanni F, Tremoli E. Molecular pathways activation in coronary artery bypass surgery. J Cardiovasc Med (Hagerstown) 2016; 17:54-61. [DOI: 10.2459/jcm.0000000000000293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Sevuk U, Altindag R, Baysal E, Yaylak B, Adiyaman MS, Akkaya S, Ay N, Alp V. The effects of hyperoxaemia on tissue oxygenation in patients with a nadir haematocrit lower than 20% during cardiopulmonary bypass. Perfusion 2015. [PMID: 26205807 DOI: 10.1177/0267659115595281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Excessive haemodilution and the resulting anaemia during CPB is accompanied by a decrease in the total arterial oxygen content, which may impair tissue oxygen delivery. Hyperoxic ventilation has been proven to improve tissue oxygenation in different pathophysiological states of anaemic tissue hypoxia. The aim of this study was to examine the influence of arterial hyperoxaemia on tissue oxygenation during CPB. Records of patients undergoing isolated CABG with CPB were retrospectively reviewed. Patients with nadir haematocrit levels below 20% during CPB were included in the study. Tissue hypoxia was defined as hyperlactataemia (lactate >2.2 mmol/L) coupled with low ScVO2 (ScVO2 <70%) during CPB. One hundred patients with normoxaemia and 100 patients with hyperoxaemia were included in the study. Patients with hyperoxaemia had lower tissue hypoxia incidence than patients with normoxaemia (p<0.001). Compared with patients without tissue hypoxia, patients with tissue hypoxia had significantly lower PaO2 values (p<0.001) and nadir haematocrit levels (p<0.001). Nadir haematocrit levels <18% (OR: 5.3; 95% CI: 2.67-10.6; p<0.001) and hyperoxaemia (OR: 0.28; 95% CI: 0.14-0.56; p<0.001) were independently associated with tissue hypoxia. CONCLUSIONS Hyperoxaemia during CPB may be protective against tissue hypoxia in patients with nadir haematocrit levels <20%.
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Affiliation(s)
- Utkan Sevuk
- Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Rojhat Altindag
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Erkan Baysal
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Baris Yaylak
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Sahin Adiyaman
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Suleyman Akkaya
- Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Nurettin Ay
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Vahhac Alp
- Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Zakkar M, Guida G, Suleiman MS, Angelini GD. Cardiopulmonary bypass and oxidative stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:189863. [PMID: 25722792 PMCID: PMC4334937 DOI: 10.1155/2015/189863] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/19/2015] [Indexed: 12/13/2022]
Abstract
The development of the cardiopulmonary bypass (CPB) revolutionized cardiac surgery and contributed immensely to improved patients outcomes. CPB is associated with the activation of different coagulation, proinflammatory, survival cascades and altered redox state. Haemolysis, ischaemia, and perfusion injury and neutrophils activation during CPB play a pivotal role in oxidative stress and the associated activation of proinflammatory and proapoptotic signalling pathways which can affect the function and recovery of multiple organs such as the myocardium, lungs, and kidneys and influence clinical outcomes. The administration of agents with antioxidant properties during surgery either intravenously or in the cardioplegia solution may reduce ROS burst and oxidative stress during CPB. Alternatively, the use of modified circuits such as minibypass can modify both proinflammatory responses and oxidative stress.
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Affiliation(s)
- Mustafa Zakkar
- Bristol Royal Infirmary, Level 7, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Gustavo Guida
- Bristol Royal Infirmary, Level 7, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M-Saadeh Suleiman
- Bristol Royal Infirmary, Level 7, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - Gianni D. Angelini
- Bristol Royal Infirmary, Level 7, Upper Maudlin Street, Bristol BS2 8HW, UK
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Kramer PA, Chacko BK, Ravi S, Johnson MS, Mitchell T, Barnes S, Arabshahi A, Dell’Italia LJ, George DJ, Steele C, George JF, Darley-Usmar VM, Melby SJ. Hemoglobin-associated oxidative stress in the pericardial compartment of postoperative cardiac surgery patients. J Transl Med 2015; 95:132-41. [PMID: 25437645 PMCID: PMC4422823 DOI: 10.1038/labinvest.2014.144] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/09/2014] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis and valvular heart disease often require treatment with corrective surgery to prevent future myocardial infarction, ischemic heart disease, and heart failure. Mechanisms underlying the development of the associated complications of surgery are multifactorial and have been linked to inflammation and oxidative stress, classically as measured in the blood or plasma of patients. Postoperative pericardial fluid (PO-PCF) has not been investigated in depth with respect to the potential to induce oxidative stress. This is important because cardiac surgery disrupts the integrity of the pericardial membrane surrounding the heart and causes significant alterations in the composition of the pericardial fluid (PCF). This includes contamination with hemolyzed blood and high concentrations of oxidized hemoglobin, which suggests that cardiac surgery results in oxidative stress within the pericardial space. Accordingly, we tested the hypothesis that PO-PCF is highly pro-oxidant and that the potential interaction between inflammatory cell-derived hydrogen peroxide with hemoglobin is associated with oxidative stress. Blood and PCF were collected from 31 patients at the time of surgery and postoperatively from 4 to 48 h after coronary artery bypass grafting, valve replacement, or valve repair (mitral or aortic). PO-PCF contained high concentrations of neutrophils and monocytes, which are capable of generating elevated amounts of superoxide and hydrogen peroxide through the oxidative burst. In addition, PO-PCF primed naive neutrophils resulting in an enhanced oxidative burst upon stimulation. The PO-PCF also contained increased concentrations of cell-free oxidized hemoglobin that was associated with elevated levels of F2α isoprostanes and prostaglandins, consistent with both oxidative stress and activation of cyclooxygenase. Lastly, protein analysis of the PO-PCF revealed evidence of protein thiol oxidation and protein carbonylation. We conclude that PO-PCF is highly pro-oxidant and speculate that it may contribute to the risk of postoperative complications.
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Affiliation(s)
- Philip A. Kramer
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Balu K. Chacko
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Saranya Ravi
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Michelle S. Johnson
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Tanecia Mitchell
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Stephen Barnes
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Targeted Metabolomics and Proteomics Laboratory, Department of Pharmacology and Toxicology, University of Alabama at Birmingham, AL 35294
| | - Alireza Arabshahi
- Targeted Metabolomics and Proteomics Laboratory, Department of Pharmacology and Toxicology, University of Alabama at Birmingham, AL 35294
| | - Louis J. Dell’Italia
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Heart Failure Research, Division of Cardiovascular Sciences, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294,Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - David J. George
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Chad Steele
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - James F. George
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Victor M. Darley-Usmar
- Mitochondrial Medicine Laboratory, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Spencer J. Melby
- Center for Free Radical Biology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294,Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294,Corresponding author.
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Stevanovic A, Coburn M, Menon A, Rossaint R, Heyland D, Schälte G, Werker T, Wonisch W, Kiehntopf M, Goetzenich A, Rex S, Stoppe C. The importance of intraoperative selenium blood levels on organ dysfunction in patients undergoing off-pump cardiac surgery: a randomised controlled trial. PLoS One 2014; 9:e104222. [PMID: 25118980 PMCID: PMC4132095 DOI: 10.1371/journal.pone.0104222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/21/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiac surgery is accompanied by an increase of oxidative stress, a significantly reduced antioxidant (AOX) capacity, postoperative inflammation, all of which may promote the development of organ dysfunction and an increase in mortality. Selenium is an essential co-factor of various antioxidant enzymes. We hypothesized a less pronounced decrease of circulating selenium levels in patients undergoing off-pump coronary artery bypass (OPCAB) surgery due to less intraoperative oxidative stress. METHODS In this prospective randomised, interventional trial, 40 patients scheduled for elective coronary artery bypass grafting were randomly assigned to undergo either on-pump or OPCAB-surgery, if both techniques were feasible for the single patient. Clinical data, myocardial damage assessed by myocard specific creatine kinase isoenzyme (CK-MB), circulating whole blood levels of selenium, oxidative stress assessed by asymmetric dimethylarginine (ADMA) levels, antioxidant capacity determined by glutathionperoxidase (GPx) levels and perioperative inflammation represented by interleukin-6 (IL-6) levels were measured at predefined perioperative time points. RESULTS At end of surgery, both groups showed a comparable decrease of circulating selenium concentrations. Likewise, levels of oxidative stress and IL-6 were comparable in both groups. Selenium levels correlated with antioxidant capacity (GPx: r = 0.720; p<0.001) and showed a negative correlation to myocardial damage (CK-MB: r = -0.571, p<0.001). Low postoperative selenium levels had a high predictive value for the occurrence of any postoperative complication. CONCLUSIONS OPCAB surgery is not associated with less oxidative stress and a better preservation of the circulating selenium pool than on-pump surgery. Low postoperative selenium levels are predictive for the development of complications. TRIAL REGISTRATION ClinicalTrials.gov NCT01409057.
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Affiliation(s)
- Ana Stevanovic
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Mark Coburn
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Ares Menon
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Daren Heyland
- Kingston General Hospital, Kingston, Ontario, Canada
| | - Gereon Schälte
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Thilo Werker
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Willibald Wonisch
- Institute of Physiological Chemistry, Centre for Physiological Medicine, Medical University of Graz, Graz, Austria
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Michael Kiehntopf
- Institute of Clinical Chemistry, Friedrich-Schiller University, Jena, Germany
| | - Andreas Goetzenich
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
| | - Steffen Rex
- Department of Anaesthesiology and Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Belgium
| | - Christian Stoppe
- Department of Anaesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
- Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, Aachen, Germany
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Plicner D, Mazur P, Sadowski J, Undas A. Asymmetric dimethylarginine and oxidative stress following coronary artery bypass grafting: associations with postoperative outcome. Eur J Cardiothorac Surg 2014; 45:e136-41. [PMID: 24523493 DOI: 10.1093/ejcts/ezt646] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Elevated asymmetric dimethylarginine (ADMA) is associated with an increased risk of coronary artery disease. A prognostic value of ADMA following coronary artery bypass grafting (CABG) is unknown. The aim of the current study was to assess the effect of CABG on ADMA and oxidative stress and determine their associations with postoperative complications. METHODS In 158 consecutive patients (35 women, 123 men, aged 65.2 ± standard deviation 8.2 years) undergoing isolated, elective CABG procedure, we measured plasma ADMA and 8-iso-prostaglandin F2α (8-iso-PGF2α) preoperatively and twice postoperatively: 18-36 h and 5-7 days after surgery. The primary end points were postoperative myocardial infarction (PMI) and in-hospital cardiovascular death. RESULTS ADMA increased from 0.56 ± 0.06 μmol/l at baseline by 68% to 0.94 ± 0.11 μmol/l at 18-36 h after CABG, and then decreased by 20% to 0.75 ± 0.12 μmol/l on 5-7 days postoperatively (P = 0.0001 for all comparisons). A similar pattern of changes was observed for 8-iso-PGF2α. Thirteen (8.2%) patients developed PMI, and 6 patients (3.8%) died during the early postoperative period because of extensive PMI. PMI and early perioperative mortality were positively associated with ADMA and 8-iso-PGF2α. CONCLUSIONS A marked increase of ADMA and oxidative stress is observed within the first days following CABG, and is associated with unfavourable early post-CABG outcomes, including PMI and in-hospital cardiovascular death.
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Affiliation(s)
- Dariusz Plicner
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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McDonald CI, Fraser JF, Coombes JS, Fung YL. Oxidative stress during extracorporeal circulation. Eur J Cardiothorac Surg 2014; 46:937-43. [PMID: 24482384 DOI: 10.1093/ejcts/ezt637] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is an increased oxidative stress response in patients having cardiac surgery, haemodialysis or extracorporeal membrane oxygenation that is related to poorer outcomes and increased mortality. Exposure of the patients' blood to the artificial surfaces of these extracorporeal devices, coupled with inflammatory responses, hyperoxia and the pathophysiological aspects of the underlying illness itself, all contribute to this oxidative stress response. Oxidative stress occurs when there is a disruption of redox signalling and loss of control of redox balance. Ongoing oxidative stress occurring during extracorporeal circulation (ECC) results in damage to lipids, proteins and DNA and contributes to morbidity and mortality. This review discusses reactive species generation and the potential clinical consequences of oxidative stress during ECC as well as provides an overview of some current antioxidant compounds that are available to potentially mitigate the oxidative stress response.
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Affiliation(s)
- Charles Ian McDonald
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Jeff S Coombes
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Yoke Lin Fung
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
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Hall R. Identification of Inflammatory Mediators and Their Modulation by Strategies for the Management of the Systemic Inflammatory Response During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:983-1033. [DOI: 10.1053/j.jvca.2012.09.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Indexed: 12/21/2022]
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DiMaria-Ghalili RA, Sullivan-Marx EM, Compher C. Inflammation, Functional Status, and Weight Loss During Recovery From Cardiac Surgery in Older Adults. Biol Res Nurs 2013; 16:344-52. [DOI: 10.1177/1099800413503489] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4–6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study ( n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time ( p < .05). IL-6 increased over time ( p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures ( p < .05). Grip strength decreased in those who developed complications ( p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores ( p < .05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.
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Affiliation(s)
- Rose Ann DiMaria-Ghalili
- Doctoral Nursing Department and Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Charlene Compher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Rahsepar AA, Mirzaee A, Moodi F, Moohebati M, Tavallaie S, Khorashadizadeh F, Eshraghi A, Alavi MS, Zarrabi L, Sajjadian M, Amini M, Khojasteh R, Paydar R, Mousavi S, Ghayour-Mobarhan M, Ferns GA. Changes in anti-heat shock protein 27 antibody and C-reactive protein levels following cardiac surgery and their association with cardiac function in patients with cardiovascular disease. Cell Stress Chaperones 2013; 18:65-74. [PMID: 22843452 PMCID: PMC3508121 DOI: 10.1007/s12192-012-0358-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 07/12/2012] [Accepted: 07/13/2012] [Indexed: 01/25/2023] Open
Abstract
The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E' (r = -0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen-antibody, and antibody levels were higher at the time of discharge.
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Affiliation(s)
- Amir Ali Rahsepar
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
- Biochemistry of Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Asadollah Mirzaee
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
- Department of Cardiovascular Surgery, Quem Hospital, Mashhad University of Medical Science, Mashhad, Iran
| | - Fatemeh Moodi
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Moohebati
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Shima Tavallaie
- Biochemistry of Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Fatemeh Khorashadizadeh
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Ali Eshraghi
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Maryam-Sadat Alavi
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Laya Zarrabi
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mostafa Sajjadian
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Maral Amini
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Roshanak Khojasteh
- Biochemistry of Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Roghayeh Paydar
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Somayeh Mousavi
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
- Biochemistry of Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Gordon A. Ferns
- Institute for Science & Technology in Medicine, Thornburrow Drive, University of Keele, Stoke on Trent, Staffordshire ST4 7QB UK
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Mariscalco G, Dominici C, Beghi C. Reply. Ann Thorac Surg 2012. [DOI: 10.1016/j.athoracsur.2012.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cresci G, Hummell AC, Raheem SA, Cole D. Nutrition intervention in the critically ill cardiothoracic patient. Nutr Clin Pract 2012; 27:323-34. [PMID: 22516943 DOI: 10.1177/0884533612444135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Despite acute myocardial infarction and cardiac surgery accounting for 2 of the most common reasons patients are admitted to the intensive care unit, little attention and investigation have been directed specifically for these patients. This patient population therefore deserves special attention as they are often malnourished but require emergent interventions, making nutrition intervention challenging. This article reviews current medical interventions implemented in critically ill cardiothoracic patients and discusses evidence-based nutrition therapy, including enteral and parenteral feeding, glycemic control, and antioxidant provision.
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Affiliation(s)
- Gail Cresci
- Cleveland Clinic, Gastroenterology and Pathobiology, Cleveland, OH 44195, USA.
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High perioperative level of oxidative stress as a prognostic tool for identifying patients with a high risk of recurrence of head and neck squamous cell carcinoma. Int J Clin Oncol 2010; 15:565-70. [PMID: 20632055 DOI: 10.1007/s10147-010-0108-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of the study was to investigate the relationships among (a) glutathione peroxidase (GPx) and malondialdehyde (MDA); (b) oncological characteristics (i.e., TNM classification, tumor grade), and; (c) prognosis of head and neck squamous cell carcinoma. METHODS In a prospective cohort study, we followed 88 patients for 67.4 months (median 40.3) after surgery for head and neck squamous cell carcinoma. Activity of GPx was determined by ELISA and plasma MDA concentration by liquid chromatography. RESULTS Lower GPx activity was observed in the T3/4 patients than in the T1/2 group. Tumor grade was significantly correlated with both GPx (P = 0.001) and MDA (P = 0.05, both Spearman). The perioperative level of MDA was higher in patients who later recurred during the follow-up period (n = 15) than in the complete remission group (P = 0.01, Mann-Whitney). Median disease-free interval and overall survival in the group with MDA > median were 29.5 and 32.0 months, respectively, and 38.4 and 40.3 months in the patient group with MDA ≤ median (P = 0.10 and P = 0.08, respectively; Kaplan-Meier). Patients with MDA levels higher than the median had a more than twofold greater risk of recurrence than patients with MDA levels smaller than the median (31.3 vs. 15.2%, P = 0.06, logrank). CONCLUSION Our results suggest that an increased MDA level at the time of initial surgery is found in patients with a high risk of recurrence, which suggests that each patient can be categorized according to risk of recurrence based on their MDA level at the time of initial surgery.
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