Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1-42 levels?

BACKGROUND: Postoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of ß-amyloid (Aß) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aß1-42 concentrations has not yet been conducted. METHODS: The research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aß1-42 concentrations were collected. RESULTS: The neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aß1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed. CONCLUSIONS: The conducted research confirmed the earlier suspected association of plasmatic Aß1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.

Independent factors FOR poor prognosis in young patients with stage I-III breast cancer.

Breast cancer is the most common malignancy in the population of women under 40 years of age. Young age is an independent factor for poor prognosis. In this research, we tried to establish other factors for poor prognosis in stage I-III breast cancer. The following parameters were observed: tumor size, lymph node status, histologic grade, hormonal receptor status, Ki-67 prognostic index, Her2 neu status, histologic type of the tumor, local recurrence and metastases. Logistic regression was used to evaluate the effect of specific factors on the probability of lethal outcome and development of distant metastases. Our patients showed a predominance of T1 tumor (49.4%), had positive lymph nodes (62%) and most of them were pN1 (61.2%). Up to one-third of patients had triple negative status. Ki-67 proliferation index was high (25%). Multicentric tumor was detected in 23% of patients. There was no difference in overall survival between the two types of surgical procedures. Patients with pN0 status had better overall survival. Breast cancer in the population of young women has a more aggressive nature. Study results indicated positive lymph node status as an independent factor for poor prognosis of stage I-III breast cancer.