Martin Bäckström

S100β after coronary artery surgery: release pattern, source of contamination, and relation to neuropsychological outcome

BACKGROUND S100beta has been suggested as a marker of brain damage after cardiac operation. The aim of this study was to characterize the early S100beta release in detail and relate it to neuropsychological outcome. METHODS Three groups of patients were investigated. All patients underwent coronary artery bypass surgery (CABG) with extracorporeal circulation. In group A, 110 patients had sampling of S100beta for the first 10 postoperative hours and also underwent neuropsychological testing. In group B, 14 patients were examined for the effect of autotransfusion on S100beta levels. Eight patients in group C had their intraoperative bleeding processed with a cell-saving device. RESULTS Group A had a heterogeneous release pattern with several rapid elevations in S100beta concentration. In group B, high concentrations of S100beta were found in the autotransfusion blood (range 0.2 to 210 microg/L) with a concurrent elevation of serum S100beta levels after transfusion of shed blood. In group C, high levels of S100beta were found in the blood from the surgical field (12.0+/-6.0 microg/L) and decreased (1.1+/-0.64 microg/L) after wash. Group C had significantly lower S100beta values at the end of cardiopulmonary bypass compared to group A (0.53+/-0.35 microg/L versus 2.40+/-1.5 microg/L). S100beta values were corrected for extracerebral contamination with a kinetic model. With this correction, an association was found between adverse neuropsychological outcome and S100beta release in group A (r = 0.39, p < 0.02). CONCLUSIONS A significant amount of S100beta is found both in the blood from the surgical field and in the shed mediastinal blood postoperatively. Infusion of this blood will result in infusion of S100beta into the blood and interfere in the interpretation of early systemic S100beta values.

Structural modeling of generalized prejudice: The role of social dominance, authoritarianism, and empathy

Structural equation modeling on questionnaire data showed that prejudice toward different target groups can be represented in terms of a general prejudice factor. Distinction of classical and modern prejudice only increased model fit marginally. In two separate samples (paper and pencil vs. Internet) several structural models of the relationship between key individual difference variables and prejudice were tested, revealing highly similar results. Social dominance orientation, empathy, and right-wing authoritarianism had direct effects on generalized prejudice. The effect of participant sex on generalized prejudice, where the men scored higher, was largely mediated by empathy. The benefit of including empathy in structural models of prejudice is emphasized.

Higher-Order Factors in a Five-Factor Personality Inventory and its Relation to Social Desirability

This paper compared two higher-order factor models using a 100-item, five-factor personality inventory originating from the IPIP database. The sample consisted of 2,019 subjects tested on the Internet. The two models were compared using confirmatory factor analysis. The two-factor model showed a similar fit to the data. The criteria for parsimony favored a hierarchical model with one higher-order factor at the top and five personality factors beneath. The single higher-order factor was found to be related to social desirability in a subsample of 196 subjects.

Measuring adult attachment: A construct validation of two self–report instruments

This study reports the Swedish construct validation of two translated attachment style scales. The factor structure of the attachment construct was investigated via exploratory and confirmatory factor analyses of attachment scores from 515 students of a Swedish university. Results supported the expected two-factor solution, but found a three-factor solution to be a viable alternative. In addition, the attachment scales were compared with the Big Five personality inventory (NEO-PI), using a sample of 87 Swedish students, and found to have expected correlation to this scale.

Personality and self‐variables: important determinants of subjective quality of life in schizophrenia out‐patients

Objective: To investigate factors determining severely mentally ill patients’ self‐rated quality of life. The study hypothesized that objective life circumstances, personality, self‐variables, and psychopathology would be determinants of quality of life.

The Effect of Response Style on Self-Reported Conscientiousness Across 20 Countries:

Rankings of countries on mean levels of self-reported Conscientiousness continue to puzzle researchers. Based on the hypothesis that cross-cultural differences in the tendency to prefer extreme response categories of ordinal rating scales over moderate categories can influence the comparability of self-reports, this study investigated possible effects of response style on the mean levels of self-reported Conscientiousness in 22 samples from 20 countries. Extreme and neutral responding were estimated based on respondents’ ratings of 30 hypothetical people described in short vignettes. In the vignette ratings, clear cross-sample differences in extreme and neutral responding emerged. These responding style differences were correlated with mean self-reported Conscientiousness scores. Correcting self-reports for extreme and neutral responding changed sample rankings of Conscientiousness, as well as the predictive validities of these rankings for external criteria. The findings suggest that the puzzling country rankings of self-reported Conscientiousness may to some extent result from differences in response styles.

A model of subjective quality of life for outpatients with schizophrenia and other psychoses.

This study investigated predictors of quality of life among persons with schizophrenia and other psychoses. On the basis of previous research, it was hypothesised that objective life circumstances, self-variables, psychopathology, activity level, satisfaction with daily activities, and satisfaction with medical care would be determinants of quality of life. 134 persons were investigated, and the analysis was based on Structural Equation Modelling (SEM). A model with two quality of life variables, General quality of life and Security, fitted the data best. A self-variable, Sense of self, and Satisfaction with daily activities, Psychopathology, and Satisfaction with medical care served as mediators and explained the variation in the quality of life variables. External to the mediators, and related to these, were Activity level, Educational level, and Independent living. In conclusion, a self-variable showed the strongest association with quality of life, but two aspects that should be feasible to influence in mental health care, daily activity and medical care, contributed to the subjects’ self-rated quality of life. These results render a somewhat optimistic view on how to accomplish a better self-perceived quality of life among people with severe mental illness.

In the eye of both patient and spouse: memory is poor 1 to 2 years after coronary bypass and angioplasty.

BACKGROUND The study aimed to investigate patient and spouse perception of cognitive functioning 1 to 2 years after coronary artery bypass grafting. METHODS Seventy-six married patients who had undergone coronary artery bypass grafting were selected and sex- and age-matched with 75 concurrent married patients who had undergone percutaneous transluminal coronary angioplasty. Couples received a letter of explanation and then completed telephone interviews. Forty-seven questions assessed memory, concentration, general health, social functioning, and emotional state. Response choices were: improved, unchanged, or deteriorated function after coronary artery bypass grafting/percutaneous transluminal coronary angioplasty. RESULTS Patients who had undergone coronary artery bypass grafting did not differ in subjective ratings on any measure from patients who had undergone percutaneous transluminal coronary angioplasty. There were no differences between spouses in the respective groups; spouse ratings also did not differ from patient ratings. Only in memory function did patients and spouses report a postprocedural decline. CONCLUSIONS No subjective differences were found in patients who had undergone either coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. Spouse ratings agreed with each other and with patient ratings. Positive correlations were found between the questionnaire factors, suggesting that perceived health and well-being are associated with subjective cognition.

Controversial significance of early S100B levels after cardiac surgery

BackgroundThe brain-derived protein S100B has been shown to be a useful marker of brain injury of different etiologies. Cognitive dysfunction after cardiac surgery using cardiopulmonary bypass has been reported to occur in up to 70% of patients. In this study we tried to evaluate S100B as a marker for cognitive dysfunction after coronary bypass surgery with cardiopulmonary bypass in a model where the inflow of S100B from shed mediastinal blood was corrected for.Methods56 patients scheduled for coronary artery bypass grafting underwent prospective neuropsychological testing. The test scores were standardized and an impairment index was constructed. S100B was sampled at the end of surgery, hourly for the first 6 hours, and then 8, 10, 15, 24 and 48 hours after surgery. None of the patients received autotransfusion.ResultsIn simple linear analysis, no significant relation was found between S100B levels and neuropsychological outcome. In a backwards stepwise regression analysis the three variables, S100B levels at the end of cardiopulmonary bypass, S100B levels 1 hour later and the age of the patients were found to explain part of the neuropsychological deterioration (r = 0.49, p < 0.005).ConclusionsIn this study we found that S100B levels 1 hour after surgery seem to be the most informative. Our attempt to control the increased levels of S100B caused by contamination from the surgical field did not yield different results. We conclude that the clinical value of S100B as a predictive measurement of postoperative cognitive dysfunction after cardiac surgery is limited.

Increased S100B in blood after cardiac surgery is a powerful predictor of late mortality

BACKGROUND Long-term outcome in patients who suffered stroke after undergoing a cardiac operation has been investigated sparingly, but increased long-term mortality has been reported. S100B is a biochemical marker of brain cell ischemia and blood-brain barrier dysfunction. The aim of this investigation was to record the long-term mortality in consecutive patients undergoing cardiac operations and to explore whether increased concentrations of S100B in blood had a predictive value for mortality. METHODS Prospectively collected clinical variables, including S100B, in 767 patients who survived more than 30 days after a cardiac operation, were analyzed with actuarial survival analysis and 678 patients were analyzed with Cox multiple regression analysis. RESULTS Forty-nine patients (6.4%) were dead at follow-up (range, 18 to 42 months); 11.5% (88 of 767 patients) had elevated S100B 2 days after operation (range, 38 to 42 hours). The probability for death at follow-up was 0.239 if the S100B level was more than 0.3 microg/L, and 0.041 if it was less than 0.3 microg/L. The clinical variables independently associated with mortality were preoperative renal failure, preoperative low left ventricular ejection fraction, emergency operation, severe postoperative central nervous system complication, and elevated S100B values, which turned out to be the most powerful predictor. CONCLUSIONS Even slightly elevated S100B values in blood 2 days after cardiac operation imply a bad prognosis for outcome, and especially so in combination with any central nervous system complication.