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      Plasma BNP level combined with surgical Apgar score to predict operative major cardiac adverse events in malignant obstructive jaundice patients

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          Abstract

          Objective:

          To investigate the predictive effect of major adverse cardiac events (MACE) in malignant obstructive jaundice (OJ) patients using plasma brain natriuretic peptide (BNP) level and surgical Apgar scoring (SAS) system.

          Methods:

          Forty one malignant OJ patients undergoing surgical treatments were studied at a single center. Pre-and postoperative plasma BNP level, total bilirubin (TBil) and data of cardiac function (HR, CVP, CI, LVEF%) were detected, the SAS was calculated during the surgery, the relationship of both plasma BNP level and SAS with MACE after surgery was analyzed.

          Results:

          Thirteen patients out of 41 (31.71%) experienced MACE without cardiac death. OJ patients had a higher plasma BNP level than baseline before operation (191.61±105.76 pg/ml VS 175 pg/ml, P<0.05), the cardiac function data was improved (CVP: t=4.761, p=0.000; CI: t=3.539, p=0.001; LVEF%: t=3.632, p=0.001) after the operation. Patients with lower SAS had increasing incidence of MACE after surgery.

          Conclusion:

          Malignant OJ patients with higher preoperative BNP level and lower surgical Apgar score were identified at high risk of MACE after surgery.

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          Most cited references 33

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          An Apgar score for surgery.

          Surgical teams have not had a routine, reliable measure of patient condition at the end of an operation. We aimed to develop an Apgar score for the field of surgery, an outcomes score that teams could calculate at the end of any general or vascular surgical procedure to accurately grade a patient's condition and chances of major complications or death. We derived our surgical score in a retrospective analysis of data from medical records and the National Surgical Quality Improvement Program for 303 randomly selected patients undergoing colectomy at Brigham and Women's Hospital, Boston. The primary outcomes measure was incidence of major complication or death within 30 days of operation. We validated the score in two prospective, randomly selected cohorts: 102 colectomy patients and 767 patients undergoing general or vascular operations at the same institution. A 10-point score based on a patient's estimated amount of blood loss, lowest heart rate, and lowest mean arterial pressure during general or vascular operations was significantly associated with major complications or death within 30 days (p < 0.0001; c-index = 0.72). Of 767 general and vascular surgery patients, 29 (3.8%) had a surgical score
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            Brain and other natriuretic peptides: molecular aspects.

            Natriuretic peptides have emerged as important candidates for development of diagnostic tools and therapeutic agents in cardiovascular disease. The family contains of three major peptides-ANP, BNP, CNP-that participate in cardiovascular and cardiorenal homeostasis. Each of these natriuretic peptides binds differentially to specific receptors that signal through different mechanisms. They are cleared enzymatically by neutral endopeptidase as well as by receptor-mediated endocytosis. Because of its fast induction and specific expression in overt heart failure, BNP seems the most promising natriuretic peptide. It is predominantly synthesized in the cardiac ventricles, released as pre-proBNP and then enzymatically cleaved to BNP and the N-terminal portion of BNP(NT-proBNP). Blood measurements of BNP and NT-proBNP have been shown to identify patients with LV dysfunction. This review focuses on the physiology of natriuretic peptides as a group and brain natriuretic peptide in more detail, its structure and regulation as well as its effects at the cellular level.
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              Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation.

              Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Sep-Oct 2016
                : 32
                : 5
                : 1188-1193
                Affiliations
                [1 ]Wei Yu, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [2 ]Changshan Huang, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [3 ]Qian Wang, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [4 ]Erjiang Zhao, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [5 ]Yuechao Ding, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [6 ]Tao Huang, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [7 ]Chao Ma, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                [8 ]Bo Meng, Department of Hepatobiliary & Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou 450008, China
                Author notes
                Correspondence: Wei Yu, MD. Department of Hepatobiliary& Pancreatic Surgery, Affiliated Tumor Hospital of Zhengzhou University, No. 127 Dongming Road, Zhengzhou 450008, Henan Province, China. E-mail: yuweihn@ 123456yeah.net
                Article
                PJMS-32-1188
                10.12669/pjms.325.10302
                5103131
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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