Cardiac surgery induces a significant inflammatory hypermetabolic stress response, resulting in postoperative hyperglycemia in both preoperatively diabetic and nondiabetic patients. Such postoperative hyperglycemia has been associated with adverse outcomes in surgery and postsurgical recovery. Yet, while diabetes is a known risk factor for postoperative hyperglycemia, predictors of postoperative hyperglycemia among nondiabetics in the local Southeast Asian population remain unknown. We aim to investigate the predictors and outcomes associated with hyperglycemia after cardiac surgery among nondiabetics in the local Southeast Asian population. We analyzed data from 1602 nondiabetic adult patients undergoing elective cardiac surgery, from 2008 to 2010 at the 2 main heart centers in Singapore. Nondiabetic patients who developed postoperative hyperglycemia tended to be women, older, more obese, and hypertensive. Higher body mass index (BMI), age, aortic cross-clamp time, and blood transfusion were identified as independent risk factors of postoperative hyperglycemia. Postoperative hyperglycemia was also significantly associated with postoperative cardiac arrhythmias (26.9% vs 15.0%, P < .001), acute kidney injury (30.0% vs 20.1%, P < .001), longer intensive care unit (ICU) stay (46.7 ± 104.1 vs 37.2 ± 76.6 hours, P = .044) and longer hospitalization (11.5 ± 12.2 vs 9.6 ± 8.0 days, P < .001). Our study identified aortic cross-clamp time and blood transfusion as independent risk factors of postoperative hyperglycemia after cardiac surgery in nondiabetics. Similar to other studies, higher BMI and age were independent risk factors for postoperative hyperglycemia. Postoperative hyperglycemia was also associated with adverse perioperative outcomes and should thereby be avoided by treating modifiable risk factors identified in this study including reducing blood transfusion and aortic cross-clamp time. Our findings contribute to early risk stratification of nondiabetic patients who are at increased risk of postoperative hyperglycemia.

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PurposeThe Attune® Knee System provides new instrumentation to achieve symmetric flexion/extension gaps in total knee arthroplasty (TKA). However, there is limited information on the optimal TKA technique using this system. The aim of this randomised controlled trial was to determine which surgical technique results in better postoperative clinical outcomes after TKA using the contemporary Attune® Knee System: the measured resection or gap balancing technique. MethodsA prospective randomized controlled trial was conducted with 100 patients undergoing TKA using measured resection (n = 50) or gap balancing (n = 50) technique. The measured femoral sizer was used in the measured resection group, while the balanced femoral sizer was used in the gap balancing group. Functional outcomes and quality of life were assessed preoperatively and at 6 months and 2 years post‐surgery, using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), the Physical Component Score (PCS) and Mental Component Score (MCS) of Short‐Form 36 (SF‐36). Using weight‐bearing coronal radiographs, the hip‐knee‐ankle angle (HKA), coronal femoral component angle (CFA), coronal tibial component angle (CTA) and joint line height were also evaluated for each patient. ResultsThere were no significant differences in the functional scores or the proportion of patients from each group who were satisfied or had their expectations fulfilled at 6 months or 2 years post‐surgery. There was also no significant difference in the number of patients who attained minimum clinically important difference (MCID) postoperatively between the groups. Postoperatively, there was no significant difference in the number of HKA outliers between the groups (p = 0.202). The postoperative CFA (p = 0.265) and CTA (p = 0.479) were similar between the groups. There was also no significant difference in the absolute change (p = 0.447) or proportion of outliers (p = 0.611) for joint line height between the groups. ConclusionBoth measured resection and gap balancing techniques resulted in comparable functional and quality of life outcomes up to 2 years post‐surgery. Both techniques appear to be equally effective in achieving excellent outcomes with the Attune® Knee System. Level of evidenceI.

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Duchenne and Becker muscular dystrophies (DMD/BMD) are X-linked recessive disorders caused by mutations in the DMD gene. Emerging therapies targeting patients with specific mutations are now becoming a reality for many of these patients. Precise molecular diagnosis is essential to facilitate the identification of possible new treatments for patients in the local context. In this study, we screened 145 dystrophinopathic patients in Singapore and assessed their molecular status for eligibility to current emerging genetic therapies. Overall, 140 (96.5%) of all patients harbored pathogenic DMD mutations comprising 95 exonic deletions (65.5%), 14 exonic duplications (9.7%), and 31 pathogenic small mutations (21.4%). Nonsense and frameshift mutations constitute 83.9% of all the small mutations. We found 71% (103/145) of all Singaporean dystrophinopathy patients to be theoretically amenable for exon skipping, either through skipping of single (53.1%) or multiple exons (17.9%).This approach is applicable to 81.1% (77/95) of patients carrying deletions and 83.9% (26/31) of those with small mutations. Eteplirsen induced skipping of exon 51 is applicable to 12.4% of local patients. Nonsense read-through therapy was found to be applicable in another 12.4% of all patients. Mutation screening is crucial for providing insights into the underlying genetic signature of the disease in the local population and contributes toward existing information on DMD mutations in Asia and globally. This will guide future targeted drug development and clinical trial planning for this disease. K E Y W O R D SBecker muscular dystrophy, Duchenne muscular dystrophy, dystrophinopathy, genetic diagnosis, mutation spectrum