Tumor necrosis factor gene expression is induced locally during acute pancreatitis, resulting in large amounts of intrapancreatic TNF with levels consistently higher than those found in the serum. The overall rise in both tissue and serum TNF concentrations correlates directly with the severity of pancreatic damage and inflammation. The infiltrating macrophage appears to contribute most to this process.

Background-Atrial fibrillation (AF) developing after cardiac surgery is associated with adverse outcomes; however, the mechanism(s) that trigger and maintain AF in these patients are unknown.

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CHF was more common with solid myxomas, and neurologic and embolization events were more common in the papillary type. Septal tumor location showed strong association with CHF, while extraseptal location correlated with neurologic events. We speculate that the various gross and microscopic patterns reflect secondary changes within these neoplasms over the course of their natural history.

Objectives To determine if serum markers for collagen I and III synthesis, the C-terminal peptide from Pro-collagen-I (PICP) and the N-terminal peptide from Pro-Collagen III (PIIINP), correlate with LA fibrosis and post-operative AF. Background Atrial fibrillation (AF) after cardiac surgery is associated with adverse outcomes. We recently demonstrated that left atrial (LA) fibrosis is associated with post-operative AF in patients with no previous history of AF. Methods Fifty-four patients having cardiac surgery without a history of AF consented to left and right atrial biopsies, and a pre-operative peripheral blood draw. Picrosirius red staining quantified the percentage of fibrosis, and RT-PCR assessed atrial tissue mRNA transcripts involved in the fibrosis pathway. PICP and PIIINP levels were measured using an enzyme immunosorbant assay. Results Eighteen patients developed AF, while 36 remained in normal sinus rhythm (NSR). Left atrial fibrosis was higher in patients who developed AF vs. NSR (6.13 ±2.9% vs. 2.03± 1.9%, p =0.03). LA mRNA transcripts for collagen I, III, transforming growth factor, and angiotensin were 1.5-2.0 fold higher in AF patients. Serum PICP and PIIINP levels were highest in AF vs. NSR (PICP: 451.7±200 vs. 293.3±114 ng/ml, p=0.006; PIIINP: 379±286 vs. 191.6±162 pg/ml, p=0.01). Further there was a linear correlation between LA fibrosis and serum PICP levels (R2= 0.2; p = 0.01), and of the markers only PICP was independently associated with AF. Conclusions This demonstrates that serum PICP and PIIINP levels correlate with the presence of left atrial fibrosis and may act as a predictor for post-operative AF even in the absence of previous history of AF.