NT-Pro BNP Secretion and Clinical Endpoints in Cardiac Surgery Intensive Care Patients

The primary objective of this study was to determine the pattern of N-Terminal pro brain natriuretic peptide (NT-pro BNP) secretion pre and post cardiac surgery and then to investigate the correlation between levels of serum NT-pro BNP and postoperative clinical and biochemical endpoints. This was a prospective observational study performed at a tertiary centre in New Zealand, examining 118 adult patients undergoing cardiac surgery. Interventions included blood samples for NT-Pro BNP and troponin-T taken 48 hours prior to operation and 12, 36 and 72 hours postoperatively. The plasma NT-pro BNP levels increased fourfold postoperatively, to plateau at 36 to 72 hours. Preoperative NT-pro BNP levels correlated with ventilation time (r=0.46), length of stay in intensive care unit (r=0.59), total perioperative noradrenaline dose (r=0.55), but not with postoperative atrial fibrillation or mortality. Using multivariate analysis, serum NT-pro BNP levels at 36 hours were associated with increased noradrenaline dose (P=0.001), decreased preoperative ejection fraction (EF) Group (P=0.013) and elevated preoperative NT-pro BNP (P <0.001). Factors not associated with NT-pro BNP levels at 36 hours include the operation type, bypass and cross-clamp times, use of milrinone and troponin-T. We conclude that NT-pro BNP levels increased markedly after cardiac surgery and that high preoperative NT-pro BNP levels are associated with a slow postoperative recovery, but do not predict the occurrence of postoperative atrial fibrillation or mortality. Myocardial ischaemia is an unlikely cause of the NT-pro BNP elevation, because no correlation existed between troponin-T and NT-pro BNP levels.

Variation in Arterial Access for Invasive Coronary Procedures in New Zealand: A National Analysis (ANZACS-QI 5)

BACKGROUND

Radial arterial access (RA) and femoral arterial access (FA) rates for invasive coronary angiography (ICA) vary widely internationally. The European Society of Cardiology (ESC) suggests default RA is feasible. We aim to investigate the variation in RA rates across all New Zealand public hospitals.

METHODS AND RESULTS

Patient characteristics, procedural details, and inpatient outcome data were collected in the All New Zealand Acute Coronary Syndrome - Quality Improvement (ANZACS-QI) registry on consecutive patients undergoing ICA over five months. Of the 5894 ICAs 81% were via RA. Hospitals averaged 25 - 176 procedures/month (46.5% - 96.4% via RA). Operators averaged 17 procedures/month. Those performing more than 20 ICAs/month had RA rates between 61% - 99%. Of the 75 operators, 69% met the ESC recommendation. After multivariable adjustment higher operator (RR 1.12, CI 1.09 - 1.30) and hospital (RR 1.21, CI 1.15 - 1.28) volume were independent predictors of RA. Those with prior CABG (RR 0.51, CI 0.45 - 0.57), STEMI <12h (RR 0.91, CI 0.87 - 0.96), and female sex (RR 0.96, CI 0.94 - 0.99) were less likely to receive RA.

CONCLUSIONS

New Zealand has a high RA rate for ICAs. Rates vary substantially between both operators and centres. Radial arterial was highest amongst the highest volume operators and centres.

Activation of KV7 channels stimulates vasodilatation of human placental chorionic plate arteries

INTRODUCTION

Potassium (K(+)) channels are key regulators of vascular smooth muscle cell (VSMC) excitability. In systemic small arteries, Kv7 channel expression/activity has been noted and a role in vascular tone regulation demonstrated. We aimed to demonstrate functional Kv7 channels in human fetoplacental small arteries.

METHODS

Human placental chorionic plate arteries (CPAs) were obtained at term. CPA responses to Kv7 channel modulators was determined by wire myography. Presence of Kv7 channel mRNA (encoded by KCNQ1-5) and protein expression were assessed by RT-PCR and immunohistochemistry/immunofluorescence, respectively.

RESULTS

Kv7 channel blockade with linopirdine increased CPA basal tone and AVP-induced contraction. Pre-contracted CPAs (AVP; 80 mM K(+) depolarization solution) exhibited significant relaxation to flupirtine, retigabine, the acrylamide (S)-1, and (S) BMS-204352, differential activators of Kv7.1 - Kv7.5 channels. All CPAs assessed expressed KCNQ1 and KCNQ3-5 mRNA; KCNQ2 was expressed only in a subset of CPAs. Kv7 protein expression was confirmed in intact CPAs and isolated VSMCs.

DISCUSSION

Kv7 channels are present and active in fetoplacental vessels, contributing to vascular tone regulation in normal pregnancy. Targeting these channels may represent a therapeutic intervention in pregnancies complicated by increased vascular resistance.

Large-scale discovery of novel genetic causes of developmental disorders

Despite three decades of successful, predominantly phenotype-driven discovery of the genetic causes of monogenic disorders, up to half of children with severe developmental disorders of probable genetic origin remain without a genetic diagnosis. Particularly challenging are those disorders rare enough to have eluded recognition as a discrete clinical entity, those with highly variable clinical manifestations, and those that are difficult to distinguish from other, very similar, disorders. Here we demonstrate the power of using an unbiased genotype-driven approach to identify subsets of patients with similar disorders. By studying 1,133 children with severe, undiagnosed developmental disorders, and their parents, using a combination of exome sequencing and array-based detection of chromosomal rearrangements, we discovered 12 novel genes associated with developmental disorders. These newly implicated genes increase by 10% (from 28% to 31%) the proportion of children that could be diagnosed. Clustering of missense mutations in six of these newly implicated genes suggests that normal development is being perturbed by an activating or dominant-negative mechanism. Our findings demonstrate the value of adopting a comprehensive strategy, both genome-wide and nationwide, to elucidate the underlying causes of rare genetic disorders.

Identification of lead sources in residential environments: Sydney Australia

Interior and exterior dust, soil and paint were analysed at five brick urban Sydney homes over 15 months to evaluate temporal variations and discriminate sources of lead (Pb) exposure. Exterior dust gauge Pb loading rates (μg/m(2)/28 days), interior vacuum dust Pb concentrations (mg/kg) and interior petri-dish Pb loading rates (μg/m(2)/28 days), were correlated positively with soil Pb concentrations. Exterior dust gauge Pb loading rates and interior vacuum dust Pb concentrations peaked in the summer. Lead isotope and Pb speciation (XAS) were analysed in soil and vacuum dust samples from three of the five houses that had elevated Pb concentrations. Results show that the source of interior dust lead was primarily from soil in two of the three houses and from soil and Pb paint in the third home. IEUBK child blood Pb modelling predicts that children's blood Pb levels could exceed 5 μg/dL in two of the five houses.

The Evaluation of Flash Point and Cold Filter Plugging Point with Blends of Diesel and Cyn-Diesel Pyrolysis Fuel for Automotive Engines

The production of synthetic fuels from alternative sources has increased in recent years as a cleaner, more sustainable source of transport fuel is now required. The European Commission has outlined renewable energy targets pertaining to transport fuel which must be met by 2020. In response to these targets Ireland has committed, through the Biofuels Obligation Scheme of 2008, to producing 3% of transport fuels from biofuels by 2010 and 10% by 2020. In order to be suitable for sale in Europe, diesel fuels and biodiesels must meet certain European fuel specifications outlined in the EN 590:2009 standard. The aim of this paper was to prepare blends of varying proportions of synthetic diesel (Cyn-diesel) fuel, produced from the pyrolysis of plastic, vs regular fossil diesel. The flash point (°C) and cold filter plugging point (°C) of these blends as well as of the conventional petroleum diesel fuel were analysed in relation to compliance with the European fuel standard EN 590. The results confirmed that blending of Cyn-diesel with conventional petroleum diesel has a highly significant effect on the properties of the resulting fuel blend. The results show that by increasing the Cyn-diesel content of the blend, the flash point of the blend decreases and the cold filter plugging point increases. Furthermore, comparing the fuel blends to EN 590 specifications has highlighted significant trends. The cold filter plugging points of all of the fuel blends are in compliance with EN 590 specifications. However, only blends of up to, and including, 40% Cyn-diesel are in compliance with EN 590 specifications for flash point. This analysis shows that a blend of 40% Cyndiesel is in compliance with all of the EN 590 specifications examined, and as such could be placed on the European fuel market (provided that the blend meets the requirements for the other properties in the EN 590 specification). This finding highlights the potential for Cyn-diesel blends to be incorporated into the European and national renewable energy targets.