Mu-Opioid Receptor 1 and C-Reactive Protein Single Nucleotide Polymorphisms as Biomarkers of Pain Intensity and Opioid Consumption.

Children constitute a special group in pain therapy. Single nucleotide polymorphisms that are associated with differences in postoperative, inflammatory pain perception and opioid requirement are the A118G SNP in the mu-opioid receptor 1 (OPRM1) gene and the rs1205 CRP. This study aimed to determine connection between OPRM1 and rs1205 CRP SNPs in pediatric patients postoperatively and pain intensity, the opioid dose needed to control pain after scoliosis correction, and other clinical aspects. Genotypes of rs1205 CRP and OPRM1 polymorphisms in a sample of 31 patients were specified, and statistical analysis was performed in terms of age, genotype frequency, pain assessment, sufentanil flow, post-anesthesia care unit stay, and the use of coanalgesics. The frequency of A/A and A/G genotypes in the OPRM1 gene was in line with 1000Genomes data for the European population. Patients from the AG group of OPRM1 SNP more frequently required coanalgesics for adequate pain control; however, it was of weak statistical significance. Other parameters measured in the study were not statistically significant in relation to OPRM1 and CRP polymorphisms. The effect of SNPs on postoperative pain management and opioid therapy in children was not confirmed by this study. An expansion of the study sample and other opioid-related SNPs is required.

PECAM-1/Thrombus Ratio Correlates with Blood Loss during Off-Pump Coronary Artery Bypass Grafting (OPCAB) Surgery: A Preliminary Study.

Platelet endothelial cell adhesion molecule 1 (PECAM-1) is considered an antiplatelet molecule. Previously, we introduced a new parameter called the PECAM-1/thrombus ratio, which indicates the proportion of PECAM-1 in the thrombus and provides a precise description of human platelet activity (in vitro). The aim of this study was to determine whether the PECAM-1/thrombus ratio could serve as a predictive factor for bleeding events during off-pump coronary artery bypass grafting (OPCAB). To achieve this, we collected blood samples from 20 patients scheduled to undergo OPCAB surgery. We assessed the PECAM-1/thrombus ratio by evaluating thrombus formation on collagen fibers under flow conditions. Subsequently, we compared the ability of the PECAM-1/thrombus ratio in predicting bleeding risk with other methods that evaluate hemostasis activity. These methods included assessing platelet P-selectin secretion, platelet exposure of phosphatidylserine, plasma coagulation and fibrinolysis system activity, and thrombus formation using the T-TAS assay. Our findings revealed a positive correlation between the PECAM-1/thrombus ratio and the amount of blood component units transfused (BCUT) during the OPCAB surgery. Furthermore, BCUT did not show any significant correlation with other measured hemostasis parameters. This preliminary study suggests that the PECAM-1/thrombus ratio might be a good predictor of bleeding risk during the OPCAB procedure.

Infective endocarditis of the tricuspid valve. Surgical treatment with pericardial cylinder implantation.

Introduction: Infective endocarditis (IE) on the tricuspid valve usually requires the complete resection of the infected tissue and implantation of a valve prosthesis. Aim: We assumed that total elimination of artificial material and implantation of the entirely patient-derived biological material would reduce the recurrence of IE. Material and methods: The group consisted of 7 consecutive patients who underwent implantation of a cylindrical valve created from the patient's own pericardium in the tricuspid orifice. There were only men aged 43 to 73 years. Isolated tricuspid valve reimplantation with a pericardial cylinder was performed in 2 patients. Five (71%) patients needed additional procedures. The postoperative follow-up ranged from 2 to 32 months (median: 17 months). Results: In patients who underwent isolated tissue cylinder implantation, the average extracorporeal circulation (ECC) time was 77.5 minutes and aortic cross-clamp time was 58 minutes. In cases where additional procedures were performed the ECC and X-clamp times were 197.4 and 156.2 minutes, respectively. The function of the implanted valve was examined after weaning from the ECC by transesophageal echocardiogram, followed by transthoracic echocardiogram on day 5-7 after surgery revealed normal function of the prosthesis in all patients. There was no operative mortality. Two late deaths were observed. Conclusions: In the follow-up period none of the patients had a recurrence of IE within the pericardial cylinder. Degeneration with subsequent stenosis of the pericardial cylinder occurred in 3 patients. One patient was reoperated on; one had a transcatheter valve-in-valve cylinder implantation.

Endogenic erythropoietin secretion in patients undergoing off-pump coronary artery bypass grafting.

BACKGROUND: Erythropoietin (EPO) deficiency or inadequate EPO secretion in response to bleeding may result in profound or prolonged anaemia after cardiac surgery. AIM: The aim of the study was to evaluate the changes in EPO secretion in patients undergoing off-pump coronary artery bypass grafting (OPCAB). METHODS: Blood samples from 43 patients (mean age 65.1 ± 7.6 years) were obtained before surgery and on the 1st, 2nd, and 6th day post isolated OPCAB. EPO levels ≥ 4.3 mIU/mL were considered normal. RESULTS: Thirteen (30%) patients had the preoperative EPO level below normal range even though their preoperative haemoglobin was ≥ 13 g/dL. In patients with basal EPO deficiency lower peak EPO levels were observed compared to the group with normal basal EPO levels, even though reduction in haemoglobin concentrations was comparable in both groups. Moreover, lower reticulocytosis was noted on day 1 (8.5 ± 4.0‰ vs. 11.7 ± 4.4‰; p = 0.04) and a tendency toward lower values was seen on day 2 (9.6 ± 4.3‰ vs. 13.0 ± 5.8‰; p = 0.07) among patients with preoperative EPO deficiency. CONCLUSIONS: Erythropoietin deficiency is common in patients scheduled for OPCAB, and it results in diminished increase in EPO secretion in response to bleeding. Consequently, in patients with EPO deficiency, reticulocytosis is lower than it could be predicted based on the observation of patients with normal EPO levels and similar blood loss.

[Mechanical valve replacement in tricuspid (systemic) position in a patient with corrected transposition of the great arteries]. / Implantacja protezy mechanicznej w pozycje trójdzielna (systemowa) u chorego ze skorygowanym przelozeniem wielkich pni naczyniowych.

The authors report a case of a 55 year-old male with corrected transposition of the great arteries and severe tricuspid (systemic) regurgitation treated with anatomical mechanical tricuspid valve replacement.