Statin use is associated with a rise of FPG in patients with and without diabetes. This relationship between statin use and rise in FPG is independent of age and use of aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors.
BackgroundMini-sternotomy for isolated aortic valve replacement aims to reduce operative trauma hastening recovery and improving the cosmetic outcome of cardiac surgery. The short-term clinical benefits from the mini-sternotomy are presumed to arise because the incision is less extensive and the lower half of the chest cage remains intact. The basic conduct of virtually all other aspects of the aortic valve replacement procedure remains the same. Therefore, similar long-term outcomes are to be expected.ObjectivesTo conduct a meta-analysis of the only available randomised controlled trials (RCT) in the published English literature.Data sourcesElectronic search for relevant publications in MEDLINE, EMBASE and CENTRAL databases were performed. Four studies met the criteria.Study eligibility criteriaRCT comparing minimally invasive (inverted C or L (J)-shaped) hemi-sternotomy versus conventional sternotomy for adults undergoing isolated aortic valve replacement using standard cardiopulmonary bypass technique.MethodsOutcome measures were the length of positive pressure ventilation, blood loss, intensive care unit (ICU) and hospital stay.ResultsThe length of ICU stay was significantly shorter by 0.57 days in favour of the mini-sternotomy group (CI −0.95 to −0.2; p=0.003). There was no advantage in terms of duration of ventilation (CI −3.48 to 0.36; p=0.11). However, there was some evidence to suggest a reduction in blood loss and the length of stay in hospital in the mini-sternotomy group. This did not prove to be statistically significant (154.17 ml reduction (CI −324.51 to 16.17; p=0.08) and 2.03 days less (CI −4.12 to 0.05; p=0.06), respectively).LimitationsThis study includes a relatively small number of subjects (n=220) and outcome variables. The risk of bias was not assessed during this meta-analysis.ConclusionMini-sternotomy for isolated aortic valve replacement significantly reduces the length of stay in the cardiac ICU. Other short-term benefits may include a reduction in blood loss or the length of hospital stay.
Neurodegenerative diseases are largely defined by protein aggregates in affected tissues. Aggregates contain some shared components as well as proteins thought to be specific for each disease. Aggregation has not previously been reported in the normal, aging heart or the hypertensive heart. Detergent-insoluble protein aggregates were isolated from mouse heart and characterized on 2D gels. Their levels increased markedly and significantly with aging and following sustained angiotensin-II-induced hypertension. Of the aggregate components identified by high-resolution proteomics, half changed in abundance with age (392/787) or with sustained hypertension (459/824), while 30% (273/901) changed concordantly in both, each P<0.05. One fifth of these proteins were previously associated with age-progressive neurodegenerative and/or cardiovascular diseases — e.g. ApoE, ApoJ, ApoA-IV, clusterin, complement C3, and others involved in stress-response and protein-homeostasis pathways. Since fibrosis is a characteristic of both aged and hypertensive hearts, we posited that aging of fibroblasts may contribute to the aggregates observed in cardiac tissue. Indeed, as cardiac myofibroblasts “senesced” (approached their replicative limit) in vitro, they accrued aggregates with many of the same constituent proteins observed in vivo during natural aging or sustained hypertension. In summary, we have shown for the first time that compact (detergent-insoluble) protein aggregates accumulate during natural aging, chronic hypertension and in vitro myofibroblast senescence, sharing many common proteins. Thus, aggregates that arise from disparate causes (aging, hypertension, replicative senescence) may have common underlying mechanisms of accrual.
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