Role of preoperative blood markers as prognostic factors for lung cancer surgery.

OBJECTIVE: This study was undertaken to assess the potential value of preoperative blood components as prognostic markers of outcome after lung cancer resection, and hence their potential to aid in the selection of patients for curative surgery. METHODS: This was a single-center study on 313 patients who underwent surgery for non-small-cell lung cancer from 2006 to 2008. Data were analyzed retrospectively from a prospectively maintained thoracic database. Preoperative blood results including plasma fibrinogen levels, serum C-reactive protein, hemoglobin concentration, and platelet count were included in the analysis. RESULTS: The mean age was 75 years, and 40% of the patients were females. The most common resection was lobectomy in 68% of patients, followed by pneumonectomy, wedge resection, and segmentectomy in 18%, 10%, and 1.6%, respectively. Patients with abnormal C-reactive protein, fibrinogen, and hemoglobin levels had a worse overall survival. Large tumor size and nodal metastasis on clinical staging was also associated with poor survival. However, on Cox regression analysis, plasma fibrinogen and nodal metastasis were the only independent predictors of survival after lung resection. CONCLUSIONS: Among the different blood markers, elevated preoperative plasma fibrinogen was an independent marker of reduced survival in patients with resected non-small-cell lung cancer, and its value in selecting patients who may benefit from surgery needs further investigation.

Current randomized control trials, observational studies and meta analysis in off-pump coronary surgery.

The off-pump literature is divided into three eras: the "early phase" with results favouring off-pump surgery supported with randomized control trials (RCTs) mainly from Bristol, UK; an "intermediate phase" dominated by the results of the ROOBY trial and finally a more "contemporary phase" whereby the off/on-pump argument is unsettled. Although the literature has failed to project an overall superiority of off-pump versus on-pump surgery, nevertheless, small randomized control trials and large meta-analysis studies are concluding that the incidence of a stroke is less than 1 % when an aortic off-pump techniques (especially the non-touch technique) are advocated in patients with diseased ascending aorta. Furthermore, off-pump combined with hybrid procedures may lead to a reduction of adverse outcome in the aged high-risk population with concomitant poor left ventricular function and co-morbidities.The current review attempts to bring an insight onto the last ten years knowledge on the on/off-pump debate, with an aim to draw some clear conclusions in order to allow practitioners to reflect on the subject.

Bi-lateral changes to hippocampal cholesterol levels during epileptogenesis and in chronic epilepsy following focal-onset status epilepticus in mice.

Brain cholesterol homeostasis has been shown to be disrupted in neurodegenerative conditions such as Alzheimer's and Huntington's diseases. Investigations in animal models of seizure-induced brain injury suggest that brain cholesterol levels are altered by prolonged seizures (status epilepticus) and are a feature of the pathophysiology of temporal lobe epilepsy. The present study measured hippocampal sterol levels in a model of unilateral hippocampal injury triggered by focal-onset status epilepticus, and in chronically epileptic mice. Status epilepticus was induced by intra-amygdala microinjection of kainic acid and ipsilateral and contralateral hippocampus analyzed. No significant changes were found for ipsilateral or contralateral hippocampal levels of desmosterol or lathosterol at any time after SE as measured by gas chromatography-mass spectrometry. 24S-hydroxycholesterol and cholesterol levels were unchanged up to 24h after status epilepticus but were decreased in the ipsilateral hippocampus during early epileptogenesis and in chronically epileptic mice. Levels of cholesterol were also reduced in the contralateral hippocampus during epileptogenesis and in chronic epileptic mice. Treatment of mice with the anti-inflammatory cholesterol synthesis inhibitor lovastatin did not alter seizures during status epilepticus or seizure-induced neuronal death. Thus, changes to hippocampal cholesterol homeostasis predominantly begin during epileptogenesis, occur bi-laterally even when the initial precipitating injury is unilateral, and continue into the chronic epileptic period.