Short-term outcome comparison of Norwood procedures with right ventricle to pulmonary artery conduit versus modified Blalock-Taussig shunt: A meta-analysis.

A small number of nonrandomized and retrospective studies have compared outcomes of classical Norwood procedures for hypoplasticleft-heart syndrome and single ventricle lesions involving a Blalock-Taussig (BT) shunt to the modified procedure using a right ventricle to pulmonary artery conduit. Some of these studies reported data for the same outcomes and a meta-analysis was done to analyze pooled outcomes comparing in-hospital mortality, interstage mortality, cardiopulmonary bypass time, systolic and diastolic blood pressures 24 h postoperatively, length of intensive care and hospital stay, and need for postoperative extracorporeal membrane oxygenation. Right ventricle to pulmonary artery conduit was associated with an insignificant reduction of in-hospital mortality (odds ratio, 0.674, 95% confidence interval, 0.367 to 1.238), and in the length of hospital stay. There were significant reductions in cardiopulmonary bypass time, length of intensive care unit stay, and need for postoperative extracorporeal membrane oxygenation, postoperative ventilation times, and interstage mortality (odds ratio, 0.191, confidence interval, 0.0620 to 0.587). There was a significant increase in diastolic blood pressure and an insignificant increase in systolic blood pressure 24 h postoperatively. This pooled analysis demonstrates potential advantages associated with the right ventricle to pulmonary artery conduit when compared to the modified BT shunt in palliation and demonstrates the need for large randomized controlled trials that compare a number of outcomes in both procedures.

Rate of peripheral glucose change during cognitive testing predicts performance in diabetes mellitus.

BACKGROUND: The reason for cognitive deterioration in diabetes mellitus (DM) remains unknown. One suggestion is that despite elevated glucose levels, patients with DM generally have difficulty utilizing glucose during cognitive tasks. This assumption was tested in the present study. METHODS: Male outpatients with DM (n = 46; age 52-85 years) were administered a series of standard neuropsychological and cognitive tests. In addition to assessing the time to complete the series of tests, peripheral blood glucose levels were measured prior to and following testing. RESULTS: The rate at which peripheral blood glucose levels changed was examined in relation to cognitive performance. Multiple linear regression analyses revealed significant relationships between the rate of glucose change and performance on tests measuring psychomotor skills, attention, visuoperceptual abilities, sequencing skills, mental flexibility, and planning. Higher rates of decline in peripheral blood glucose levels were associated with better performance on all cognitive measures, except verbal fluency. CONCLUSIONS: During cognitive testing, higher rates of decline in peripheral blood glucose levels may reflect stronger glucose utilization by the brain, thereby facilitating higher levels of cognitive performance. This non-invasive measure may be useful in primary care settings to provide a link between blood glucose changes and cognitive status.