Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is sca...Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.展开更多
Nearly half of orthopaedic trauma patients are intoxicated at the time of injury, and excess alcohol consumption increases the risk for fracture nonunion. Previous studies show alcohol disrupts fracture associated Wnt...Nearly half of orthopaedic trauma patients are intoxicated at the time of injury, and excess alcohol consumption increases the risk for fracture nonunion. Previous studies show alcohol disrupts fracture associated Wnt signaling required for normal bone fracture repair. Intermittent parathyroid hormone(PTH) promotes bone growth through canonical Wnt signaling, however, no studies have investigated the effect of PTH on alcohol-inhibited bone fracture repair. Male C57 BL/6 mice received two-3 day alcohol binges separated by 4 days before receiving a mid-shaft tibia fracture. Postoperatively, mice received PTH daily until euthanasia. Wnt/β-catenin signaling was analyzed at 9 days post-fracture. As previously observed, acute alcohol exposure resulted in a >2-fold decrease in total and the active form of β-catenin and a 2-fold increase in inactive β-catenin within the fracture callus. Intermittent PTH abrogated the effect of alcohol on β-catenin within the fracture callus. Upstream of β-catenin, alcohol-treated animals had a 2-fold decrease in total LRP6, the Wnt co-receptor, which was restored with PTH treatment. Alcohol nor PTH had any significant effect on GSK-3β. These data show that intermittent PTH following a tibia fracture restores normal expression of Wnt signaling proteins within the fracture callus of alcohol-treated mice.展开更多
文摘Background:Post-operative atrial fibrillation(POAF)frequently occurs after cardiac surgery.Although adult congenital heart disease(ACHD)patients have higher rates of arrhythmia than the general population,there is scant literature on POAF in ACHD patients.Objectives:Identify key risk factors associated with post-operative atrial fibrillation and evaluate the short-and mid-term significance of developing POAF.Methods:A retrospective cohort study was conducted of ACHD patients from 2013–2021 at the University of Colorado Hospital and Children’s Hospital of Colorado.The institutional Society of Thoracic Surgeons(STS)surgical registry was used to identify patients≥18-year-old with congenital heart disease who underwent cardiac surgery during the study period.Results:A total of 168 patients(48%female)were included.The median age was 36 years(IQR 28–48).Onehundred and fifty patients(90%)had moderate ACHD anatomical complexity,and 10 patients(6%)had severe ACHD anatomical complexity based on initial ACHD diagnosis.POAF occurred in 40(24%)patients.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.POAF was associated with an increased length of stay(8 vs.5 days,p<0.001)and recurrence of atrial fibrillation(46%vs.21%,OR 3.35,p=0.002)but did not predict mortality,stroke,or bleeding event.Conclusion:Atrial fibrillation is a common complication after cardiac surgery in the ACHD population.Older age,history of supraventricular tachycardia,intra-operative arrhythmia,and post-operative hypokalemia independently predicted POAF.Further investigation is needed to understand the long-term impacts of POAF.
基金AO North AmericaNational Institute on Alcohol Abuse and Alcoholism,Grant/Award Number R21AA025551 and T32AA013527。
文摘Nearly half of orthopaedic trauma patients are intoxicated at the time of injury, and excess alcohol consumption increases the risk for fracture nonunion. Previous studies show alcohol disrupts fracture associated Wnt signaling required for normal bone fracture repair. Intermittent parathyroid hormone(PTH) promotes bone growth through canonical Wnt signaling, however, no studies have investigated the effect of PTH on alcohol-inhibited bone fracture repair. Male C57 BL/6 mice received two-3 day alcohol binges separated by 4 days before receiving a mid-shaft tibia fracture. Postoperatively, mice received PTH daily until euthanasia. Wnt/β-catenin signaling was analyzed at 9 days post-fracture. As previously observed, acute alcohol exposure resulted in a >2-fold decrease in total and the active form of β-catenin and a 2-fold increase in inactive β-catenin within the fracture callus. Intermittent PTH abrogated the effect of alcohol on β-catenin within the fracture callus. Upstream of β-catenin, alcohol-treated animals had a 2-fold decrease in total LRP6, the Wnt co-receptor, which was restored with PTH treatment. Alcohol nor PTH had any significant effect on GSK-3β. These data show that intermittent PTH following a tibia fracture restores normal expression of Wnt signaling proteins within the fracture callus of alcohol-treated mice.
