European journal of clinical investigation
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Eur. J. Clin. Invest. · Sep 2006
The importance of independent risk-factors for long-term mortality prediction after cardiac surgery.
The purpose of the present study was to determine independent predictors for long-term mortality after cardiac surgery. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed to score in-hospital mortality and recent studies have shown its ability to predict long-term mortality as well. We compared forecasts based on EuroSCORE with other models based on independent predictors. ⋯ In the four models, the odds of death in the highest-risk quartile was 8.4-, 8.5-, 9.4- and 15.6-fold higher, respectively, than the odds of death in the lowest-risk quartile (P < 0.0001 for all). EuroSCORE is a good predictor of long-term mortality after cardiac surgery. We developed and validated a model using selected preoperative, intra-operative and post-operative variables that has better discriminatory ability.
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Eur. J. Clin. Invest. · Sep 2006
Bosentan for the treatment of pulmonary arterial hypertension associated with congenital heart defects.
Bosentan is an effective first-line therapy in New York Heart Association (NYHA) III patients with idiopathic pulmonary arterial hypertension (PAH). Pre-clinical data support the rationale for the potential benefit of bosentan in PAH associated with congenital heart disease (CHD). ⋯ Bosentan improves exercise capacity, functional class and haemodynamics in most patients with PAH-associated CHD, without serious side-effects, suggesting bosentan may be an important treatment option for these patients.
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Eur. J. Clin. Invest. · Sep 2006
Adipocyte fatty acid binding protein in a Caucasian population: a new marker of metabolic syndrome?
Adipocyte fatty acid binding protein (A-FABP) has been suggested as playing an important role in the pathogenesis of metabolic syndrome. The aim of this study was to evaluate serum A-FABP as a marker of metabolic syndrome and to assess its predictive accuracy in a Caucasian population. Anthropometric and serum analyses were performed for body mass index (BMI), waist circumference, A-FABP, insulin, triglycerides, total cholesterol, high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), uric acid, and glucose on 67 non-obese, healthy subjects and 71 subjects with metabolic syndrome. ⋯ The A-FABP serum level correlated with fasting levels of insulin (r = 0.34; P < 0.01), glucose (r = 0.21; P = 0.01), triglycerides (r = 0.4; P < 0.01), BMI (r = 0.57; P < 0.01) and waist circumference (r = 0.51; P < 0.01), but negatively with HDL-c (r = -0.23; P < 0.01) and Quicki (r = -0.32; P < 0.01). The relationship was defined between serum A-FABP level and metabolic syndrome diagnosis with 40% sensitivity and 99% specificity at A-FABP level 16.4 microg L(-1). Serum A-FABP level might be an independent marker of metabolic syndrome in a Caucasian population.
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Eur. J. Clin. Invest. · Sep 2006
In vivo and mechanistic evidence of nuclear receptor CAR induction by artemisinin.
Artemisinin (a sesquiterpene lactone endoperoxide) has become important in multi-drug treatment of malaria. There is evidence that artemisinin induces drug metabolism which could result in drug-drug interactions. The objective of this study was to characterize the inductive properties of artemisinin on drug-metabolizing cytochrome P450 (CYP450) enzymes. ⋯ The results demonstrate that the drug exerts its effects on drug metabolism via the CAR receptor that results in up-regulation of genes such as the Cyp2b. The weaker up-regulation of CYP2A5 might also be CAR-dependent or alternatively, a consequence of artemisinin toxicity. The results of this study are of importance when predicting potential drug-drug interactions in multi-drug therapies with artemisinin.
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Eur. J. Clin. Invest. · Aug 2006
Randomized Controlled TrialAnti-emetic prophylaxis with oral tropisetron and/or dexamethasone.
The corticosteroid dexamethasone and the serotonine3 -antagonist tropisetron are both effective drugs for the prophylaxis of post-operative nausea and vomiting (PONV) when given intravenously. The aim of this trial was to evaluate the oral use of both drugs as part of a routine oral premedication and to compare their single and combined effectiveness. ⋯ Oral tropisetron and dexamethasone were both equally effective in reducing the severity and incidence of post-operative nausea and vomiting. The latter could be reduced by approximately 35% in a population of moderate-high risk for PONV. Both drugs had an additive effect. However, even in the combination group there still remained an unacceptably high incidence of PONV of more than 20%. This highlighted the need for a multimodal anti-emetic approach in high-risk patients and the importance of treatment of PONV.