Characterization of a prospective human model for study of the reproductive hormone responses to major illness

2008 ◽  
Vol 295 (1) ◽  
pp. E63-E69 ◽  
Author(s):  
Daniel I. Spratt ◽  
Robert S. Kramer ◽  
Jeremy R. Morton ◽  
F. Lee Lucas ◽  
Karen Becker ◽  
...  
Keyword(s):  
Animal Studies ◽  
Time Course ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Serum Testosterone ◽  
Serum Levels ◽  
Reproductive Hormones ◽  
Human Model ◽  
Reproductive Hormone ◽  
Cabg Surgery

With critical illness, serum testosterone levels fall markedly, whereas estrogen levels rise. Although animal studies suggest adaptive advantages, no prospective model has been available for studies in humans. We hypothesized that coronary artery bypass graft (CABG) surgery would provide such a model by eliciting the same reproductive hormone and other endocrine responses as reported with major nonsurgical illnesses. We further hypothesized that those responses would occur consistently in all CABG patients with predictable time courses, providing reliable windows for prospective studies. In 17 men undergoing CABG, serum levels of reproductive hormones, cortisol, thyroid hormones, and IGF-I were measured before and for up to 5 wk after surgery. Changes in serum levels of reproductive and other hormones were similar to those reported in nonsurgical critically ill patients. Time course for onset, duration, and recovery of reproductive hormone changes were consistent among all patients. A window for studying the testosterone and estrogen responses was established as the first 5 days following CABG. Practical use of this model was demonstrated by evaluating, in another seven men, changes in gonadotroph responsiveness to GnRH following CABG. Finally, to determine whether our findings in CABG could be extended to other surgeries, we demonstrated similar endocrine responses in 12 men following abdominal aortic aneurysm resection. We conclude that patients undergoing CABG surgery provide a useful human model for the prospective evaluation of the reproductive axis responses to acute illness. Other major surgeries are likely to also be suitable for these studies.

Abstract 462: Effect of Coronary Revascularization on Plasma Level of Asymmetric Dimethylarginine

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Adam Nemeth ◽  
Zsofia Lenkey ◽  
Zeno Ajtay ◽  
Attila Cziraki ◽  
Endre Sulyok ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Plasma Levels ◽  
Time Course ◽  
Asymmetric Dimethylarginine ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cabg Surgery ◽  
Off Pump ◽  
Group I

Background: Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide synthase. Increased ADMA plasma levels are associated with atherosclerosis and cardiovascular disease. In this study we investigated the plasma levels of ADMA in patients who underwent different type of coronary revascularization. Methods: Concentrations of ADMA, l-arginine, symmetric dimethylarginine (SDMA) were measured by liquid chromatography-tandem mass spectrometry in four groups: group I consisted of 16 patients with ST-elevation myocardial infarction (STEMI), and group II included 24 patients who underwent elective percutaneous coronary intervention (PCI). Before PCI and at 1 hour, 5 days and 30 days after reperfusion blood samples were taken for measurement of l-arginine, ADMA and SDMA. Group III consisted of 21 patients undergoing off-pump and group IV included 20 patients undergoing on-pump coronary artery bypass graft (CABG) surgery. The measurements were performed 24 h before, 3 times during the operation (via coronary sinus catheter), and on the 1st and 5th postoperative day. Results: In patients with elective stent implantation stenting induced a prompt and sustained depression of ADMA (F=9.594, p<0.001), however ADMA remained constant for STEMI patients after stent placement (F=2.982, p=0.069). The differences in the time-course for ADMA (F=9.431, p<0.001) proved to be significant between the two groups. We did not find significant change in the plasma concentration of ADMA during off-pump CABG surgery (F=0.416, p=0.68), however ADMA concentration increased significantly in patients who underwent on-pump surgery both in the coronary sinus (F=14.751, p<0.001) and peripheral blood (F=30.738, p<0.001). Therefore, the intersubject time effect, was significant (F=6.990, p=0.002). Conclusions: The main finding of the present study is that the response pattern of the new cardiovascular risk factor, ADMA was significantly different between the two PCI and the CABG groups. Its long-term follow-up may be suitable to monitor the improvement of coronary function after revascularisation. This method should be feasible to monitor of the ADMA metabolism during coronary revascularization.

Increases in serum estrogen levels during major illness are caused by increased peripheral aromatization

2006 ◽  
Vol 291 (3) ◽  
pp. E631-E638 ◽  
Author(s):  
Daniel I. Spratt ◽  
Jeremy R. Morton ◽  
Robert S. Kramer ◽  
Sara W. Mayo ◽  
Christopher Longcope ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Animal Studies ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Serum Testosterone ◽  
Acute Illness ◽  
Clearance Rates ◽  
P450 Gene ◽  
P450 Aromatase ◽  
Aromatase Mrna

Although serum testosterone levels decrease acutely in critically ill patients, estrogen levels rise. We hypothesized that increased rates of aromatization of androgens to estrogens underlie the increase in serum estrogen levels. Eleven men and three women (age 42–69 yr) were prospectively studied before and again after elective coronary artery bypass graft surgery (CABG). Each patient received priming doses of [14C]androgen and [3H]estrogen that were immediately followed by peripheral infusions for 210 min. Eight men and three women received androstenedione (A4)/estrone (E1) and three men received testosterone (T)/estradiol (E2). Adipose tissue biopsies were obtained in another six men before and after CABG to evaluate levels of P450 aromatase mRNA. Serum T levels decreased postoperatively in all 17 men ( P < 0.001), whereas E1 levels rose ( P = 0.004), with a trend toward a rise in E2 ( P = 0.23). Peripheral aromatization rates of androgens to estrogens rose markedly in all 14 patients ( P < 0.0001). Estrogen clearance rates rose ( P < 0.002). Mean serum A4 levels increased slightly postoperatively ( P = 0.04), although no increase in A4 production rates (PRs) was observed. T PRs decreased in two of three men, whereas clearance rates increased in all three. Adipose tissue P450 aromatase mRNA content increased postoperatively ( P < 0.001). We conclude that the primary cause of increased estrogen levels in acute illness is increased aromatase P450 gene expression, resulting in enhanced aromatization of androgens to estrogens, a previously undescribed endocrine response to acute illness. Both increased T clearance and decreased T production contribute to decreased serum T levels. Animal studies suggest that these opposing changes in circulating estrogen and androgen levels may be important to reduce morbidity and mortality in critical illness.

scholarly journals Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thiago Augusto Azevedo Maranhão Cardoso ◽  
Gudrun Kunst ◽  
Caetano Nigro Neto ◽  
José de Ribamar Costa Júnior ◽  
Carlos Gustavo Santos Silva ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Volatile Anesthetic ◽  
Serum Levels ◽  
Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

scholarly journals Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

2017 ◽  
Vol 8 (1) ◽  
pp. 200-207
Author(s):  
Sarah Farukhi Ahmed ◽  
Audrey Xi Tai ◽  
Mason Schmutz ◽  
John Combs ◽  
Sameh Mosaed
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Vision Loss ◽  
Artery Bypass ◽  
Venous Pressure ◽  
Bypass Graft ◽  
Ischemic Optic Neuropathy ◽  
Cabg Surgery ◽  
Ocular Hypotony

Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

IMMUNE FUNCTION IN THE EARLY POSTOPERATIVE PERIOD PREDICTS OUTCOME IN CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY

1990 ◽  
Vol 18 (Supplement) ◽  
pp. S252
Author(s):  
Marcus P. Haw ◽  
Gregory T. Steltzer ◽  
Emma J. Lewis ◽  
Bradley C. Borlase ◽  
Lynda Kabbash ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Immune Function ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Postoperative Period ◽  
Artery Bypass Graft ◽  
Cabg Surgery

Reproductive hormone concentrations and associated anatomical responses: does soy formula affect minipuberty in boys?

2021 ◽  
Author(s):  
Helen B Chin ◽  
Andrea Kelly ◽  
Margaret A Adgent ◽  
Stacy A Patchel ◽  
Kerry James ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Serum Testosterone ◽  
Reproductive Hormones ◽  
Cow Milk ◽  
Milk Formula ◽  
Feeding Practice ◽  
Reproductive Hormone ◽  
Penile Length ◽  
High Exposure ◽  
Vaginal Cytology

Abstract Context Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. Objective To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. Design The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow-milk formula, or breastmilk feeding during study follow-up. Reproductive hormone concentrations and male anatomical measurements were longitudinally assessed from birth to 28 weeks. Setting Clinic-based cohort Participants 147 mother-infant boy pairs Interventions not applicable Main outcome measure Serum testosterone and luteinizing hormone (LH) concentrations, stretched penile length, anogenital distance, and testis volume. Results Median serum testosterone was at pubertal levels at 2 weeks [176 ng/dL (quartiles:124, 232)] and remained in this range until 12 weeks, in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n=55) and boys fed cow-milk formula (n=54). Compared with breastfed boys (n=38), soy-formula-fed boys had a more rapid increase in penile length (p=0.004) and slower initial lengthening of AGD (p=0.03), but no differences in hormone trajectories. Conclusions Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow-milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Seyed Tayeb Moradian ◽  
Fatemah Beitollahi ◽  
Mohammad Saeid Ghiasi ◽  
Amir vahedian-azimi
Keyword(s):  
Clinical Trial ◽  
Pulse Oximetry ◽  
Fast Track ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Non Invasive

Abstract Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35); the intervention group and the control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilator setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, P > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, P < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were lower in the intervention group (P < 0.05). However, the differences in the length of stay in ICU between the two groups were not significant (P = 0.219). Conclusion According to our results, the use of non-invasive monitors, including capnography and pulse oximetry, is emphasized in order to utilize FTE after CABG surgery. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Nevertheless, further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Trial registration: IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192

scholarly journals Outcome of off-pump coronary artery bypass graft (OPCAB) surgery: Analysis of 129 cases

2016 ◽  
Vol 31 (1) ◽  
pp. 23-25
Author(s):  
AKM Manzurul Alam ◽  
Istiaq Ahmed ◽  
Manzil Ahmed ◽  
Al Mamun Hossain
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Off Pump ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, including Bangladesh. Besides medical and interventional treatment, coronary artery bypass graft (CABG) surgery in an effective modality for the management of a subset of CAD patients. Off-pump coronary artery bypass graft (OPCAB) surgery is a recent modification of conventional CABG surgery, which, like other parts of the world, is being increasingly practiced in Bangladesh. But the outcome of this relatively recent surgical approach in our setting is largely unknown. In this study, the outcomes of 129 cases off-pump CABG surgery done in a tertiary cardiovascular centre and a private institute in Dhaka were analyzed. Majority (67, 54.2%) had triple vessel disease (TVD), while 4 (3.2%) patients had left main disease. One, two and three grafts were used in 17 (13.2%),74 (57.4%) and 38 (29.4%) cases respectively. There was no mortality. Post-operative complications occurred in 17 (13.18%) patients; secondary wound infection in 10 (7.75%) and immediate respiratory distress in 7 (5.43%) cases. Ten (7.75%) patients needed secondary stitches.Bangladesh Heart Journal 2016; 31(1) : 23-25

scholarly journals Determining Postoperative Thrombocyte Reduction Cut Off to Predict 30-Day Mortality in Patients Undergo Coronary Artery Bypass Graft Surgery

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4914-4914
Author(s):  
Ikhwan Rinaldi ◽  
Arif Mansjoer
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Analysis ◽  
Conflicts Of Interest ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Area Under The Curve ◽  
Early Mortality ◽  
Receiver Operating Curve ◽  
Thrombocyte Count ◽  
Cabg Surgery

Background There are many factors associated with early mortality after CABG, including postoperative thrombocytopenia (Kertai, 2016). Many factors during CABG surgery, such as administration of heparin or cardio pulmonary bypass during surgery are related to thrombocyte count reduction (Hamid, Akhtar, Naqvi, & Ahsan, 2017; Arepally, 2017). However, it is possible for a post-CABG patient to suffer a significant thrombocyte reduction without reaching the thrombocytopenic state (thrombocyte count <150000/µL). Up to this time, there is still lack of study about association between thrombocyte reduction after surgery and 30-day mortality in patients undergo CABG. This study aim to determine cut off point for postoperative thrombocyte reduction as a predictor of 30-day mortality after CABG surgery. Method This is a retrospective cohort study using medical record of 263 adult patients who underwent CABG surgery in dr. Ciptomangunkusumo National Hospital on 2012-2015. Thrombocyte reduction was determined by substracting preoperative thrombocyte count from postoperative thrombocyte count. Receiver operating curve (ROC) analysis between percentage of thrombocyte reduction and 30-day mortality after surgery was done to obtain the sensitivity and specificity value of a particular degree of thrombocyte reduction. Cut off point was obtained from intersection between sensitivity and specificity value. Result Thirty-day mortality rate after CABG surgery in this study was 11.9%. Cut off point obtained from ROC analysis was 30% with area under the curve (AUC) 0.671. The sensitivity of this cut off point to predict early mortality after CABG surgery was 64.5%, while the specificity was 64.7% Conclusion Thrombocyte reduction more than or equal to 30% can be used as a predictor of 30-day mortality after CABG surgery. Figure Disclosures No relevant conflicts of interest to declare.

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