Postoperative atrial fibrillation following non-cardiac surgery: Predictors and risk of mortality.

BACKGROUND: Postoperative atrial fibrillation (POAF) is a major complication that follows both cardiac and non-cardiac procedures. Many studies have explored POAF after cardiac procedures, however POAF following non-cardiac procedures has been understudied. METHODS: National Inpatient Sample database was utilized to conduct a retrospective study of hospitalizations with diagnosis of POAF following non-cardiac procedures between 2010 and 2015. RESULTS: 294,112 patients met the inclusion criteria. Advanced age, male gender, colonic resections, coagulopathy, fluid and electrolyte disorders and history of congestive heart failure are major predictors of POAF and in-hospital mortality. Race, type of insurance, income quartile and weekend admissions are independent determinants of mortality following POAF. CONCLUSIONS: Development of POAF and mortality is dependent upon a wide range of factors not limited to age and medical comorbidities. Although a patient may be at an increased risk for POAF this does not mean they are at an increased risk for mortality.

Aortoscopy: a guidance system for endoluminal aortic surgery.

PURPOSE: The aim of this project was to evaluate the feasibility of aortoscopy for guidance of endoluminal aortic procedures and to determine whether aortoscopy has advantages over fluoroscopy in a pig model. METHODS: To establish feasibility aortoscopic guidance was used for making endoluminal aortic measurements, cannulating small arteries for arteriograpy, and placing intraaortic stents and grafts in 11 pigs. To compare aortoscopy and fluoroscopy measurements were made and stents were placed by a surgeon using only aortoscopic guidance in 10 pigs and by an interventional radiologist using only fluoroscopic guidance in 10 pigs. Postmortem dissections were performed to determine measurement and device placement accuracy. RESULTS: In the feasibility study aortoscopic measurements differed from postmortem measurements by a mean distance (+/- SD) of 1.2 +/- 0.2 mm. Stents and grafts were placed a mean of 2.3 +/- 1.9 mm distal to the most inferior renal artery with no stent covering an orifice. All attempts at cannulating spinal arteries greater than 2 mm in diameter were successful. In the comparison of aortoscopic and fluoroscopic guidance, fluoroscopic measurements differed from postmortem measurements by 2.6 +/- 2.4 mm (p = 0.223). Stents placed with aortoscopic guidance were 1.1 +/- 1.3 mm distal to the most inferior renal artery, whereas stents placed with fluoroscopic guidance were 3.4 +/- 2.5 mm distal to the most inferior renal artery (p = 0.019). CONCLUSIONS: These results demonstrate that aortoscopy is a useful guidance system for endoluminal aortic procedures and may have advantages over fluoroscopy alone.

The determination of underivatized chlorophenols in human urine by combined high performance liquid chromatography mass spectrometry and selected ion monitoring.

A method for the determination of underivatized chlorophenols in human urine samples by combined high performance liquid chromatography mass spectrometry is described. Results obtained on individual samples are reported and compared with data obtained by alternative chromatographic methods.

The recognition of diazinon, an organophosphorus pesticide, when found in samples in the form of decomposition products.

The contents of a bottle, from which a human being was reported to have drunk and which were believed responsible to an organophosphorus poisoning, were submitted for chemical analysis. Initial screening by gas chromatography with phosphorus, sulfur, and nitrogen specific detectors failed to identify any intact organophosphorus pesticide. Mass spectrometric techniques were applied to the identification. Field ionization, field desorption, chemical ionization, exact mass measurements at high resolution, and GC/low resolution mass spectrometry were used to help define the qualitative and partial quantitative nature of the sample components. Results of this study were consistent with the virtually complete conversion of the pesticide, diazinon [Chemical Abstracts reference number 333-41-5], into a mixture of at least twenty-six chemically distinct products or impurities. The most abundant chemical compounds found in the sample included: 2-isopropyl-4-methyl-6-hydroxypyrimidine [2814-20-2]; 2-isopropyl-4-methyl-6-mercaptopyrimidine; 6,6'-dithiobis-(2-isopropyl-4-methylpyrimidine); 6,6'-dithiobis-(2-isopropyl-4-methylpyrimidine); 4-ethoxy-2-isopropyl-6-methylpyrimidine [72799-31-6]; 4-thioethoxy-2-isopropyl-6-methylpyrimidine; triethylphosphorothiolate and triethylphosphorothiolate. Also found were several potent acetylcholinesterase inhibitors: monothionotetraethylpyrophosphate; dithionotetraethylpyrophosphate [3689-24-5]; tetraethylpyrophosphate. Model decomposition studies verified the formation of these compounds. These results were then used to identify compounds in two other samples.

The identification of bile acid methyl esters by gas chromatography methane chemical ionization mass spectrometry.

Methane chemical ionization mass spectrometric data and gas chromatography retention parameters are reported for 31 bile acid methyl esters. The group includes both saturated and unsaturated compounds with up to three keto or hydroxyl groups. Major ions include the quasimolecular ions and fragments resulting from the loss of neutral species such as methanol, water and methane. The combination of gas-liquid chromatography retention and mass spectral data is sufficient for an unequivocal distinction among all the bile acids studied. Application of this data to the identification of bile acid metabolites is cited.

Microbial reduction of the side-chain carbonyl of daunorubicin and N-acetyldaunorubicin.

Microorganisms reduced the side-chain carbonyl of daunorubicin to yield 13-dihydrodaunorubicin (daunorubicinol; daunomycinol). This microbial transformation occurred under aerobic conditions in agitated baffled shake flasks incubated at 37 degrees C. The microorganisms were first grown in a medium which supported dense growth. Daunorubicin-HCl was then added. Following a period of incubation, broths were adjusted to pH 10.0 and extracted with chloroform. Daunorubicinol was recovered and purified from the chloroform extracts by preparative TLC. Identity of the daunorubicinol was established by TLC and spectroscopy (UV-vis, IR, NMR, MS, CD and ORD). N-Acetyldaunorubicin was likewise reduced microbially to N-acetyldaunorubicinol. N-Acetyldaunorubicinol appears to be a new compound which is yet to be tested for antitumor activity.